The effect of an education program on the inciderce of central venous catheter-associated bloodstream infection in a medical ICU
ABSTRACT To determine whether an education initiative could decrease the rate of catheter-associated bloodstream infection.
Preintervention and postintervention observational study.
The 19-bed medical ICU in a 1,400-bed university-affiliated urban teaching hospital.
Between January 2000 and December 2003, all patients admitted to the medical ICU were surveyed prospectively for the development of catheter-associated bloodstream infection.
A mandatory education program directed toward ICU nurses and physicians was developed by a multidisciplinary task force to highlight correct practices for the prevention of catheter-associated bloodstream infection. The program consisted of a 10-page self-study module on risk factors and practice modifications involved in catheter-related bloodstream infections and in-services at scheduled staff meetings. Each participant was required to complete a pretest before reviewing the study module and an identical test after completion of the study module. Fact sheets and posters reinforcing the information in the study module were also posted throughout the ICU.
Seventy-four episodes of catheter-associated bloodstream infection occurred in 7,879 catheter-days (9.4 per 1,000 catheter-days) in the 24 months before the introduction of the education program. Following implementation of the intervention, the rate of catheter-associated bloodstream infection decreased to 41 episodes in 7,455 catheter days (5.5 per 1,000 catheter-days) [p = 0.019]. The estimated cost savings secondary to the decreased rate of catheter-associated bloodstream infection for the 24 months following introduction of the education program was between $103,600 and $1,573,000.
An intervention focused on the education of health-care providers on the prevention of catheter-associated bloodstream infections may lead to a dramatic decrease in the incidence of primary bloodstream infections. Education programs may lead to a substantial decrease in medical-care costs and patient morbidity attributed to central venous catheterization when implemented as part of mandatory training.
- SourceAvailable from: Omar M. AL-Rawajfah
[Show abstract] [Hide abstract]
- "Numerous studies have demonstrated that educating health care workers about proper practices of IC results in a substantial decrease of HCAIs (Berenholtz et al., 2004; Warren et al., 2004, Lobo et al., 2005; Labeau et al., 2009). The Centers for Disease Control and Prevention (CDC) recommends periodic assessment of IC practices among health care workers as an effective strategy to control HCAIs (O'Grady et al., 2002). "
ABSTRACT: This study aimed to evaluate infection control (IC) practices among Jordanian registered nurses (RNs) working in intensive care unit (ICU) settings. The Centers for Disease Control and Prevention (CDC) recommends periodic assessment of IC practices for health care workers as an effective strategy to control infections. Cross-sectional descriptive design. A stratified, cluster random sampling technique was used. The sample consisted of ICU RNs from all major health care service providers and from all geographical areas in Jordan. The IC-Practices Tool (Cronbach α = 0·88) a self-report instrument was used. A total of 21 hospitals participated in the study, of which, 8 were governmental, 7 military, 4 private and 2 university-affiliated. The final sample consisted of 247 RNs from 56 critical care units. Of the total sample, 36% of RNs were from governmental hospitals. Of the total sample, 51% were female with a mean age of 28·5 years (SD = 5·2), and 54·7% worked in general ICUs. The mean overall IC practice score was 122·6 (SD = 13·2). Nurses who reported that they had been trained about IC procedures in their hospital scored higher on the IC practice scale (M = 124·3, SD = 12·3) than nurses who never received any IC training in the hospital (M = 117·3, SD = 14·6, p < 0·001). This study demonstrated the importance of conducting IC educational programmes as an effective strategy to increase staff compliance with standard IC practices. Educational role of IC nurse is important to enhance RNs compliance with standard IC practices.Nursing in Critical Care 01/2014; DOI:10.1111/nicc.12078 · 0.87 Impact Factor
[Show abstract] [Hide abstract]
- "While several studies have shown that educational initiatives have successfully reduced infections, a review of the literature demonstrated few other publications that addressed both reduced CRBSIs and cost savings realized by using simulation-based education for CVC placement      . We studied the impact of a simulation-based course as an element in the bundle of mandatory interventions implemented at our institution to decrease the incidence of CRBSIs. "
ABSTRACT: To study the impact of adding simulation-based education to the pre-intervention mandatory hospital efforts aimed at decreasing central venous catheter-related blood stream infections (CRBSI) in intensive care units (ICU). Pre- and post-intervention retrospective observational investigation. 24-bed ICU and a 562-bed university-affiliated, urban teaching hospital. ICU patients July 2004-June 2008 were studied for the development of central venous catheter related blood stream infections (CRBSI). ICU patients from July 2004-June 2008 were studied for the development of central venous catheter-related blood stream infections (CRBSI). PRE-INTERVENTION: mandatory staff and physician education began in 2004 to reduce CRBSI. The CRBSI-prevention program included online and didactic courses, and a pre- and post-test. Elements in the pre-intervention efforts included hand hygiene, full barrier precautions, use of Chlorhexidine skin preparation, and mask, gown, gloves, and hat protection for operators. A catheter-insertion cart containing all supplies and checklist were was a mandatory element of this program; a nurse was empowered to stop the procedure for non-performance of checklist items. As of July 1, 2006, a mandatory simulation-based program for all intern, resident, and fellow physicians was added to teach central venous catheter (CVC) insertion. Data collected pre- and post-intervention were CRBSI incidence, number of ICU catheter days, mortality, laboratory pathogen results, and costs. The pre-intervention CRBSI incidence of 6.47/1,000 catheter days was reduced significantly to 2.44/1,000 catheter days post-intervention (58%; P < 0.05), resulting in a $539,902 savings (USD; 47%), and was attributed to shorter ICU and hospital lengths of stay. Following simulation-based CVC program implementation, CRBSI incidence and costs were significantly reduced for two years post-intervention.Journal of clinical anesthesia 11/2012; 24(7):555-60. DOI:10.1016/j.jclinane.2012.04.006 · 1.21 Impact Factor
[Show abstract] [Hide abstract]
- "A total of 25 studies measured a change in the healthcare professional's behaviour (Kirkpatrick level 3) as an outcome measure (Ely et al. 1999; Crawford et al. 2000; Dinc & Erdil 2000; Sherertz et al. 2000; Salemi et al. 2002; Rosenthal et al. 2003; Berenholtz et al. 2004; Coopersmith et al. 2004; Velmahos et al. 2004; East & Jacoby 2005; Higuera et al. 2005; Lobo et al. 2005; Ramakrishna et al. 2005; Wall et al. 2005; Ahlin et al. 2006; Render et al. 2006; Warren et al. 2006; Bhutta et al. 2007; Britt et al. 2007; Harnage, 2007; Miranda et al. 2007; Thibodeau et al. 2007; Tsuchida et al. 2007; Xiao et al. 2007; Costello et al. 2008), and 37 measured the change in patient outcomes (Kirkpatrick level 4b) as an outcome measure (Bishop-Kurylo 1998; Bjornestam et al. 2000; Dinc & Erdil 2000; Eggimann et al. 2000; Sherertz et al. 2000; Coopersmith et al. 2002; Curchoe et al. 2002; Price et al. 2002; Salemi et al. 2002; Rosenthal et al. 2003; Warren et al. 2003; Berenholtz et al. 2004; Coopersmith et al. 2004; Gnass et al. 2004; Misset et al. 2004; Warren et al. 2004; Centers for Disease Control and Prevention 2005; Frankel et al. 2005; Higuera et al. 2005; Kennedy & Nightingale 2005; Lobo et al. 2005; Wall et al. 2005; Berriel-Cass et al. 2006; Goeschel et al. 2006; Hatler et al. 2006; Pronovost et al. 2006; Render et al. 2006; Schelonka et al. 2006; Warren et al. 2006; Young et al. 2006; Bhutta et al. 2007; Harnage 2007; Tsuchida et al. 2007; Yilmaz et al. 2007; Capretti et al. 2008; Costello et al. 2008; McKee et al. 2008). A total of 15 studies evaluated both change in healthcare professionals' behaviour "
ABSTRACT: Up to 6000 patients per year in England acquire a central venous catheter (CVC)-related bloodstream infection (Shapey et al. 2008 ). Implementation of Department of Health guidelines through educational interventions has resulted in significant and sustained reductions in CVC-related blood stream infections (Pronovost et al. 2002), and cost (Hu et al. 2004 ). This review aimed to determine the features of structured educational interventions that impact on competence in aseptic insertion technique and maintenance of CV catheters by healthcare workers. We looked at changes in infection control behaviour of healthcare workers, and considered changes in service delivery and the clinical welfare of patients involved, provided they were related directly to the delivery method of the educational intervention. A total of 9968 articles were reviewed, of which 47 articles met the inclusion criteria. Findings suggest implications for practice: First, educational interventions appear to have the most prolonged and profound effect when used in conjunction with audit, feedback, and availability of new clinical supplies consistent with the content of the education provided. Second, educational interventions will have a greater impact if baseline compliance to best practice is low. Third, repeated sessions, fed into daily practice, using practical participation appear to have a small, additional effect on practice change when compared to education alone. Active involvement from healthcare staff, in conjunction with the provision of formal responsibilities and motivation for change, may change healthcare worker practice.Medical Teacher 01/2010; 32(3):198-218. DOI:10.3109/01421591003596600 · 2.05 Impact Factor