Interventions to decrease catheter-related bloodstream infections in the ICU: The Keystone Intensive Care Unit Project

Peter Pronovost

Research output: Contribution to journalArticle

Abstract

Background: A quality improvement initiative that included rigorous measurement, feasible interventions, and cultural change was shown to nearly eliminate catheter-related bloodstream infections (CR-BSIs) in patients in a surgical intensive care unit (ICU). To build on this research, a statewide collaborative cohort study was conducted using the same evidence-based interventions. Methods: Interventions included handwashing, using full barrier precautions during the insertion of central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site if possible, and removing unnecessary catheters. Both technical and adaptive (cultural) aspects of implementing the intervention were addressed through engagement, education, execution, and rigorous evaluation. A "team checkup tool" was developed to help senior leaders assess their role in ensuring compliance. Results: Of 108 ICUs in the study, 103 reported data. Analysis included data from 1981 ICU-months and 375,757 catheter-days. The regression model showed a significant decrease in CR-BSI rates from baseline, with incidence-rate ratios decreasing from 0.62 at zero to 3 months after implementing the intervention to 0.34 at 16 to 18 months. Preliminary analysis suggested CR-BSI rates were sustained 4 years after implementation of the intervention. Conclusion: Results suggest that this program model can be generalized and be implemented on a large scale in the United States or the world to significantly reduce the rate of CR-BSIs and their associated morbidities, mortalities, and costs of care.

Original languageEnglish (US)
JournalAmerican Journal of Infection Control
Volume36
Issue number10
DOIs
StatePublished - Dec 2008

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Catheter-Related Infections
Intensive Care Units
Catheters
Hand Disinfection
Chlorhexidine
Central Venous Catheters
Critical Care
Quality Improvement
Thigh
Compliance
Cohort Studies
Morbidity
Education
Costs and Cost Analysis
Skin
Mortality
Incidence
Research

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • Epidemiology
  • Health Policy

Cite this

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abstract = "Background: A quality improvement initiative that included rigorous measurement, feasible interventions, and cultural change was shown to nearly eliminate catheter-related bloodstream infections (CR-BSIs) in patients in a surgical intensive care unit (ICU). To build on this research, a statewide collaborative cohort study was conducted using the same evidence-based interventions. Methods: Interventions included handwashing, using full barrier precautions during the insertion of central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site if possible, and removing unnecessary catheters. Both technical and adaptive (cultural) aspects of implementing the intervention were addressed through engagement, education, execution, and rigorous evaluation. A {"}team checkup tool{"} was developed to help senior leaders assess their role in ensuring compliance. Results: Of 108 ICUs in the study, 103 reported data. Analysis included data from 1981 ICU-months and 375,757 catheter-days. The regression model showed a significant decrease in CR-BSI rates from baseline, with incidence-rate ratios decreasing from 0.62 at zero to 3 months after implementing the intervention to 0.34 at 16 to 18 months. Preliminary analysis suggested CR-BSI rates were sustained 4 years after implementation of the intervention. Conclusion: Results suggest that this program model can be generalized and be implemented on a large scale in the United States or the world to significantly reduce the rate of CR-BSIs and their associated morbidities, mortalities, and costs of care.",
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