A prospective before-and-after interventional cohort study reported that evidence-based catheter-care procedures regarding hand hygiene may reduce the rate of catheter-related bloodstream infections (CRBSIs) significantly.
CRBSI are a well recognized problem in the intensive care unit (ICU), write Walter Zingg, MD, from the University Hospitals of Geneva in Geneva, Switzerland, and colleagues. A recent study, in the neonatal setting, found hand hygiene successful as a single intervention measure in reducing CRBSI when its promotion was guided by healthcare workers’ perceptions and combined with organization at the workplace. On the basis of high incidence rates of CRBSI in previous surveys of the ICUs in our institution, we decided to conduct an interventional study using an educational campaign focusing on hand hygiene and catheter care.
CRBSIs were studied at 5 adult ICUs of a university hospital in all patients with a central venous catheter (CVC) from September to December 2003 (baseline period) and from March to July 2004 (intervention period). The interventional educational program focused on hand hygiene, catheter care standards, and intravenous drug preparation. The CRBSIs rates per 1000 catheter days during the 4-month baseline period and the 5-month intervention period was the main endpoint of the study, and the secondary endpoint was compliance with hand hygiene.
The investigators studied 499 patients with 6200 catheter days in the baseline period and 500 patients with 7279 catheter days in the intervention period. There were 3.9 CRBSIs per 1000 catheter days in the baseline period, which decreased to 1.1 per 1000 catheter days in the intervention phase (P < .001). In the baseline period, both univariate and multivariate analysis revealed a significantly higher risk for CRBSIs. Independent risk factors also included hospitalization in the medical ICU and male sex.
Time to CRBSI during the intervention period, was significantly longer vs baseline (median, 9 days vs 6.5 days, respectively; P = .02). The rate of correct performance of hand hygiene improved from 22.5% to 42.6% (P = .003), although compliance with hand hygiene increased only slightly from 59% in the baseline period to 65% in the intervention period.
The study limitations included lack of randomization and disparity of the study population, with a higher fatal McCabe score, more trauma patients, longer ICU stay, longer median catheter duration, and more blood culture samples obtained in the intervention period.
Evidence-based catheter-care procedures, guided by healthcare workers’ perceptions and including bedside teaching, reduce significantly the CRBSI rate and demonstrate that improving catheter care has a major impact on its prevention, the study authors write. Infection control efforts to improve the quality of hand hygiene and catheter care are essential elements for patient safety, not only for the reduction of CRBSI but also for other health care-associated infections.