Document Detail

Eliminating catheter-related bloodstream infections in the intensive care unit.
MedLine Citation:
PMID:  15483409     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (CR-BSIs). DESIGN: Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control ICU. SETTING: The Johns Hopkins Hospital. PATIENTS: All patients with a central venous catheter in the ICU. INTERVENTION: To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed. MEASUREMENT: The primary outcome variable was the rate of CR-BSIs per 1,000 catheter days from January 1, 1998, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion. MAIN RESULTS: Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study ICU decreased from 11.3/1,000 catheter days in the first quarter of 1998 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and 1,945,922 dollars in additional costs per year in the study ICU. CONCLUSIONS: Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.
Sean M Berenholtz; Peter J Pronovost; Pamela A Lipsett; Deborah Hobson; Karen Earsing; Jason E Farley; Shelley Milanovich; Elizabeth Garrett-Mayer; Bradford D Winters; Haya R Rubin; Todd Dorman; Trish M Perl
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Critical care medicine     Volume:  32     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-10-14     Completed Date:  2004-11-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2014-20     Citation Subset:  AIM; IM    
Departments of Anesthesiology/CCM and Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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MeSH Terms
Catheterization, Central Venous / adverse effects*
Catheters, Indwelling / adverse effects*
Cohort Studies
Guideline Adherence
Intensive Care / methods
Intensive Care Units
Practice Guidelines as Topic
Prospective Studies
Quality Control
Quality of Health Care / standards*
Sepsis / prevention & control*
Grant Support
K23HL70058-01/HL/NHLBI NIH HHS; U18HS11902-02/HS/AHRQ HHS; UR8-CCU31509205/2/CC/CDC HHS
Comment In:
Crit Care Med. 2005 Jun;33(6):1466; author reply 1466   [PMID:  15942399 ]
Crit Care Med. 2004 Oct;32(10):2150-2   [PMID:  15483430 ]

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