Key Point

The rate of central line–associated bloodstream infections in the ICU can be dramatically reduced.

ATLANTA—An infection control initiative involving coordination among a large number of hospitals has proven highly successful in reducing the incidence of central line–associated bloodstream infections in ICUs. Among 32 southwestern Pennsylvania hospitals participating in the program, such infections decreased by 68% over a four-year period, a recent study reported.¹

“The experience in Pittsburgh suggests that deep reductions in central line–associated bloodstream infections are possible across a wide variety of hospitals and ICUs,” John A. Jernigan, MD, one of the study authors, told Pulmonary Reviews. “There is mounting evidence that most central–line associated bloodstream infections can be prevented, and therefore, intensive care units that do not already observe very low rates should take a careful look at their preventive practices to identify potential areas for improvement,” said Dr. Jernigan, Leader of the Intervention and Evaluation Team in the Division of Healthcare Quality Promotion at the CDC.

The CDC provided technical assistance for the study at the request of the participating hospitals, known collectively as the Pittsburgh Regional Healthcare Initiative. Among these hospitals were 69 participating ICUs, 66 of which were included in the final analysis. Of these, about half were combined medical/surgical ICUs. The rest cared for cardiothoracic, coronary, surgical, neurosurgical, trauma, medical, burn, or pediatric patients.

During the study, the ICUs implemented the following five-part intervention:

• Education of ICU staff about the prevention of central line–associated bloodstream infections.

• Adherence to targeted, evidence-based catheter insertion practices including the use of maximum sterile barrier precautions during insertion, chlorhexidine skin disinfection before insertion, avoidance of the femoral insertion site, use of recommended insertion site–dressing practices, and removal of the central line when it is no longer indicated.

• Standardized documentation of adherence to recommended catheter insertion practices.

• Use of a standardized list of contents for catheter insertion kits that includes all of the supplies necessary for adherence to recommended insertion practices.

• Sharing of each ICU’s central line–associated bloodstream infection rate in confidential quarterly reports to allow comparison with other participating ICUs and with national rates.

The participating ICUs provided data for a median of 15 of the 16 study quarters. The overall mean rate of central line–associated bloodstream infections fell from 4.31 to 1.36 per 1,000 central line days. The decrease for medical/surgical ICUs was 67%, from 3.64 to 1.18 per 1,000 central line days. For other types of ICUs, the mean decline was 69%, from 4.72 to 1.47 per 1,000 central line days. Similar improvements were observed when the analysis was limited to ICUs that reported data for all 16 quarters.

The authors pointed out that “the prevention practices promoted during this intervention were not novel; since 1996, most have been included in the Healthcare Infection Control Practices Advisory Committee recommendations for the prevention of central line–associated [bloodstream infections].” Further study is required to determine which components of the intervention were most crucial to its success, Dr. Jernigan said.

—Timothy Begany

Reference
1. Centers for Disease Control and Prevention. Reduction in central line–associated bloodstream infections among patients in intensive care units—Pennsylvania, April 2001–March 2005. MMWR Morb Mortal Wkly Rep. 2005;54:1013-1016.

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