"...CRBSI are a well recognized problem in the intensive care unit (ICU)," write Walter Zingg, MD, from the University Hospitals of Geneva in Geneva, Switzerland, and colleagues. "A recent study, in the neonatal setting, found hand hygiene successful as a single intervention measure in reducing CRBSI when its promotion was guided by healthcare workers' perceptions and combined with organization at the workplace. On the basis of high incidence rates of CRBSI in previous surveys of the ICUs in our institution, we decided to conduct an interventional study using an educational campaign focusing on hand hygiene and catheter care."
At 5 adult ICUs of a university hospital, CRBSIs were studied in all patients with a central venous catheter (CVC) from September to December 2003 (baseline period) and from March to July 2004 (intervention period). The intervention consisted of an educational program focusing on hand hygiene, catheter care standards, and intravenous drug preparation. The rate of CRBSIs per 1000 catheter days during the 4-month baseline period and the 5-month intervention period was the main endpoint of the study, and the secondary endpoint was compliance with hand hygiene.
The investigators monitored 499 patients with 6200 catheter days in the baseline period and 500 patients with 7279 catheter days in the intervention period. In the baseline period, there were 3.9 CRBSIs per 1000 catheter days, which decreased to 1.1 per 1000 catheter days in the intervention phase (P < .001). Both univariate and multivariate analysis revealed a significantly higher risk for CRBSIs in the baseline period. Hospitalization in the medical ICU and male sex were also independent risk factors.
During the intervention period, time to CRBSI was significantly longer vs baseline (median, 9 days vs 6.5 days, respectively; P = .02). Although compliance with hand hygiene increased only slightly from 59% in the baseline period to 65% in the intervention period, the rate of correct performance of hand hygiene improved from 22.5% to 42.6% (P = .003).
Limitations of this study include lack of randomization and disparity of the study population, with a higher fatal McCabe score, more trauma patients, longer ICU stay, longer median catheter duration, and more blood culture samples obtained in the intervention period.
"Evidence-based catheter-care procedures, guided by healthcare workers' perceptions and including bedside teaching, reduce significantly the CRBSI rate and demonstrate that improving catheter care has a major impact on its prevention," the study authors write. "Infection control efforts to improve the quality of hand hygiene and catheter care are essential elements for patient safety, not only for the reduction of CRBSI but also for other health care-associated infections."
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