A “simple and inexpensive” intervention to reduce ICU infections related to central catheter lines decreased the infection rate by 66% in 107 hospitals throughout Michigan, according to a new study.
The overall median rate of central catheter-related bloodstream infections was held to zero throughout 18 months of follow-up, said Dr. Peter Pronovost of Johns Hopkins University, Baltimore, and his associates (N. Engl. J. Med. 2006;355:2725–32).
The intervention, part of a statewide program to improve patient safety, targeted clinicians' use of five procedures identified by the Centers for Disease Control and Prevention as having the greatest potential to reduce infection and the greatest ease of implementation. The procedures are appropriate hand washing, using full-barrier precautions during the insertion of central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site for access if possible and removing unnecessary catheters.
A hospital-based practitioner was designated as the infection-control specialist. Clinicians were taught infection-control practices, provided with a central-line cart with necessary supplies, given a checklist to ensure adherence to infection-control practices, and stopped if they weren't following the checklist. Catheter removal was discussed every day at rounds, and ICU teams received feedback on infection rates at monthly and quarterly meetings.
This intervention was assessed at 67 Michigan hospitals of all types, which included 103 medical, surgical, cardiac, neurologic, and trauma ICUs and 1 pediatric ICU. Within 3 months of implementation, the overall median rate of central catheter-related bloodstream infection dropped from 2.7 per 1,000 catheter-days at baseline to 0. The corresponding average rates of infection were 7.7 and 2.3, respectively, Dr. Pronovost and his associates said.