Procedures to Reduce Catheter-Related Infections in the ICU
Procedures to Reduce Catheter-Related Infections in the ICU
Pronovost P, Needham D, Berenholtz S, et al
N Engl J Med. 2006;355:2725-2732
The aim of this large multicenter study was to determine whether implementation of recommended evidence-based procedures in intensive care units (ICUs), along with increased emphasis on communications, could reduce the frequency of catheter infections. The procedures included handwashing, full-barrier precautions when inserting central venous pressure (CVP) catheters, chlorhexidine skin preparation, nonuse of femoral site if possible, and prompt removal of unnecessary catheters. At the onset, the overall infection rate was 2.7/1000 catheter days (95% CI, 0.6-4.8). During implementation, the infection rate dropped to 75% of the base rate, with a further decrease to approximately 50% of base rate at 6 months and to one third of base rate at 16-18 months.
This study carried out on ICU patients demonstrated an impressive decrease in the frequency of ICU CVP catheter infections that persisted for a year and a half after implementation of the intervention program. It was not a randomized trial, so it is possible -- but unlikely -- that some other factor caused the sudden decrease in infection rate. Mortality data were not presented, but the authors estimate that such programs initiated nationally could result in 28,000 fewer deaths and an annual saving of $2.3 billion. Clearly, these simple, evidence-based procedures need to be carried out in all hospitals.
Abstract
Pronovost P, Needham D, Berenholtz S, et al
N Engl J Med. 2006;355:2725-2732
The aim of this large multicenter study was to determine whether implementation of recommended evidence-based procedures in intensive care units (ICUs), along with increased emphasis on communications, could reduce the frequency of catheter infections. The procedures included handwashing, full-barrier precautions when inserting central venous pressure (CVP) catheters, chlorhexidine skin preparation, nonuse of femoral site if possible, and prompt removal of unnecessary catheters. At the onset, the overall infection rate was 2.7/1000 catheter days (95% CI, 0.6-4.8). During implementation, the infection rate dropped to 75% of the base rate, with a further decrease to approximately 50% of base rate at 6 months and to one third of base rate at 16-18 months.
This study carried out on ICU patients demonstrated an impressive decrease in the frequency of ICU CVP catheter infections that persisted for a year and a half after implementation of the intervention program. It was not a randomized trial, so it is possible -- but unlikely -- that some other factor caused the sudden decrease in infection rate. Mortality data were not presented, but the authors estimate that such programs initiated nationally could result in 28,000 fewer deaths and an annual saving of $2.3 billion. Clearly, these simple, evidence-based procedures need to be carried out in all hospitals.
Abstract