Warren DK, Zack JE, Mayfield JL, et al: The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU

Division of Pulmonary and Critical Care, Washington University in St. Louis, San Luis, Missouri, United States
Chest (Impact Factor: 7.48). 11/2004; 126(5):1612-8. DOI: 10.1378/chest.126.5.1612
Source: PubMed


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.

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    • "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). "
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    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.
    Full-text · Article · Jan 2014 · Nursing in Critical Care
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    • "The objective of this study was to examine the effect on CLABSI rate of an external monitoring of CVC care compliance process with feedback aimed mainly at nurses. The major role of ICU nurses in reducing CLABSI rates was previously demonstrated with education programs dedicated especially to nurses [4,5]. To optimize prevention, it is now accepted that the “bundle” concept should be implemented, including five simple interventions supported by strong scientific evidence for effectiveness: optimal hand hygiene, chlorhexidine skin antisepsis, maximal barrier precautions for CVC insertion, use of optimal insertion sites, and prompt catheter removal [17]. "
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    ABSTRACT: We analyzed the impact associated with an intervention based on process control and performance feedback to decrease central line-associated bloodstream infection (CLABSI) rates.This study was conducted from March 2011 to September 2012 in five adult intensive care units (ICU) located in two Belgian tertiary hospitals A and B, with a total of 53 beds. This study was divided in three phases: P1 (baseline), P2 (intervention) and P3 (post intervention).During P2, external monitoring of five central venous catheters (CVC) care critical processes and monthly reporting (meetings and feedbacks reports posted) of performance indicators (CLABSI rate, CVC utilization ratio, compliance rate with each care process, and insertion site) to ICU workers were performed. The external monitoring of process measures was assessed by the same trained research nurse.A Poisson regression analysis was used to compare CLABSI incidence density rate per phase. Statistical significance was achieved with 2-sided p-value of <0.05. For the analysis, we separated the five ICU in hospital A and B when appropriate. Significantly improved total mean compliance was achieved for hand hygiene, CVC handling and CVC dressing. CLABSI rate declined from 4.00 (95% confidence interval (CI): 1.94-6.06) to 1.81 (0.46-3.17) per 1,000 CVC-days in P2 with an incidence rate ratio (IRR) of 0.49 (0.24-0.98, p = 0.043). A better response was observed in hospital A where the nurse participation at the monthly meeting was significantly higher than in hospital B (p < 0.001) as the percentage of feedbacks reports posted in ICU (p < 0.001). The decline in the CLABSI rate observed during P2 in comparison with P1 was independent of the insertion site (femoral or non-femoral; p = 0.054). The overall CLABSI rate increased to 2.73 (1.17-4.29) per 1,000 CVC-days with IRR of 0.67 (0.36-1.26, p = 0.212) in P3 compared to P1, but a high nursing turnover was observed in both hospitals. Our intervention focused on external auditing and performance feedback resulted in significant reduction in rates of CLABSI. Investigation continues regarding the most effective way to sustain CLABSI prevention practices and to improve the culture of safety in healthcare.
    Full-text · Article · Dec 2013
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    • "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 [3] [4] [7] [8] [9] [10]. 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. "
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    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.
    Full-text · Article · Nov 2012 · Journal of clinical anesthesia
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