Related Experiment Video
Updated: Jul 16, 2026
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach
Adnan Bhutta1, Craig Gilliam, Michele Honeycutt
1Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 800 Marshall Street, Slot 512-3, Little Rock, AR 72202, USA. bhuttaadnant@uams.edu
Insights
Implementing targeted interventions significantly reduced nosocomial infections in a pediatric intensive care unit. This study demonstrates a successful strategy for decreasing catheter-associated bloodstream infections through a multidisciplinary approach.
Area of Science:
- Healthcare-associated infections
- Infection control
- Pediatric intensive care
Background:
- Bloodstream infections linked to catheters were prevalent in a pediatric intensive care unit (PICU) between 1994-1997, exceeding national averages.
- High infection rates necessitated a proactive approach to infection control within the PICU setting.
Purpose of the Study:
- To decrease nosocomial infection rates in a PICU to below national mean rates by the year 2000.
- To achieve a 25% reduction in infection rates through a structured intervention program.
Main Methods:
- Prospective clinical data collection from 1994 onwards to monitor infection rates.
- Stepwise implementation of interventions over five years, including maximal barrier precautions, antibiotic-impregnated central venous catheters, handwashing campaigns, and changing skin disinfectants.
- Continued data collection during interventions and a subsequent three-year follow-up period.
Main Results:
- A significant, sustained decrease in infection rates was observed throughout the intervention and follow-up periods.
- Annual rates of central venous catheter-associated infections dropped from 9.7 per 1000 catheter days in 1997 to 3.0 per 1000 catheter days in 2005.
- This represents a 75% relative risk reduction, a 6% absolute risk reduction, and a number needed to treat of 16.
Conclusions:
- A stepwise, evidence-based intervention strategy can successfully achieve a threefold reduction in nosocomial infections.
- Successful implementation requires a multidisciplinary team, strong hospital leadership support, continuous data monitoring, and collaborative data interpretation.
Problem:
Bloodstream infections associated with catheters were the most common nosocomial infections in one paediatric intensive care unit in 1994-7, with rates well above the national average.
Design:
Clinical data were collected prospectively to assess the rates of infection from 1994 onwards. The high rates in 1994-7 led to the stepwise introduction of interventions over a five year period. At quarterly intervals, prospective data continued to be collected during this period and an additional three year follow-up period.
Setting:
A 292 bed tertiary care children's hospital.
Key Measures For Improvement:
We aimed to reduce our infection rates to below the national mean rates for similar units by 2000 (a 25% reduction).
Strategies For Change:
A stepwise introduction of interventions designed to reduce infection rates, including maximal barrier precautions, transition to antibiotic impregnated central venous catheters, annual handwashing campaigns, and changing the skin disinfectant from povidone-iodine to chlorhexidine. Effects of change Significant decreases in rates of infection occurred over the intervention period. These were sustained over the three year follow-up. Annual rates decreased from 9.7/1000 days with a central venous catheter in 1997 to 3.0/1000 days in 2005, which translates to a relative risk reduction of 75% (95% confidence interval 35% to 126%), an absolute risk reduction of 6% (2% to 10%), and a number needed to treat of 16 (10 to 35).
Lessons Learnt:
A stepwise introduction of interventions leading to a greater than threefold reduction in nosocomial infections can be implemented successfully. This requires a multidisciplinary team, support from hospital leadership, ongoing data collection, shared data interpretation, and introduction of evidence based interventions.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:29Endocarditis IV: Nursing Management
01:26Standard Precaution
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:23Hand hygiene
Hand washing...