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Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit

Peter Pronovost1

  • 1Quality and Safety Research Group, Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA. ppronovo@jhmi.edu

American Journal of Infection Control
|December 17, 2008
PubMed
Summary
This summary is machine-generated.

This study demonstrates that evidence-based interventions effectively reduced catheter-related bloodstream infections (CR-BSIs) in intensive care units (ICUs). The program model showed sustained CR-BSI rate reductions, suggesting broad applicability for patient safety.

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Area of Science:

  • Infection Control
  • Quality Improvement Science
  • Public Health

Background:

  • A prior initiative in a surgical ICU nearly eliminated catheter-related bloodstream infections (CR-BSIs) using quality improvement methods.
  • This study extended the research by implementing the same evidence-based interventions in a statewide collaborative cohort.

Purpose of the Study:

  • To evaluate the effectiveness of evidence-based interventions in reducing CR-BSIs across multiple ICUs.
  • To assess the generalizability and scalability of a successful CR-BSI reduction program.

Main Methods:

  • A statewide collaborative cohort study involving 103 ICUs.
  • Implementation of interventions including hand hygiene, full barrier precautions, chlorhexidine skin cleaning, and catheter site selection.
  • Addressing both technical and adaptive (cultural) aspects of implementation through engagement, education, and evaluation.

Main Results:

  • Analysis included 1981 ICU-months and 375,757 catheter-days.
  • Significant reduction in CR-BSI rates observed, with incidence-rate ratios decreasing from 0.62 to 0.34 over 18 months.
  • Preliminary data indicated sustained CR-BSI rate reductions for up to 4 years post-implementation.

Conclusions:

  • The program model is generalizable and scalable for large-scale implementation.
  • Significant reductions in CR-BSIs, associated morbidities, mortalities, and healthcare costs are achievable.
  • This approach offers a viable strategy for improving patient safety globally.