Intervention to Decrease Catheter Related Bloodstream Infection in the ICU Research Paper

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Catheter-Related Infections

Central Catheter-related ICU Infections

Central Catheter-Related Infections in ICUs

Reducing Central Catheter-Related ICU Infections in Michigan

Reducing Central Catheter-Related ICU Infections in Michigan

Teams of clinicians at five hospitals across Michigan reported their efforts to reduce the frequency of catheter-related bloodstream infections in intensive care units (ICUs) through the implementation of five patient safety measures: (1) hand washing, (2) full barrier precautions during insertion of central venous catheters, (3) use of chlorhexidine to clean the insertion site, (4) avoid using a femoral site for catheter insertion, and (5) never leaving unnecessary catheters in the patient (Pronovost et al., 2006). The intervention was based on the published research findings from five research groups: Berenholtz et al., 2004; Cohran et al., 1996; Eggimann et al., 2000; Warren et al., 2004; and Warren et al., 2006. Three of these studies investigated the efficacy of interventions on catheter-related bloodstream infections in an ICU setting, while the other two evaluated the effect of interventions more generally. All emphasized clinician education in the prevention of these infections and together this group of studies represented the evidence base upon which Pronovost and colleagues (2006) designed the intervention they tested.

The study design involved designating ICU team leaders, consisting of a physician and nurse, who would be trained in the intervention strategies (Pronovost et al., 2006).
Through a partnership with hospital-based infection-control professionals, the team leaders implemented the intervention and collected infection data. In addition to the five patient safety measures, a number of other measures were implemented, which included checklists, the creation of a central-line cart with all necessary supplies, best practice procedures preventing clinicians not adhering to guidelines from continuing, and reminders and feedback at daily rounds and meetings. The independent variable in this study was the intervention and the dependent variable (outcome) the incidence of central catheter-related ICU infections occurring over time. The study period was between March 2004 and September 2005, a full 18 months, and took place in 103 ICUs in 67 Michigan hospitals. About half of the ICUs, however, did not contribute to baseline data.

Central catheter-related infections were defined according to National Nosocomial Infections Surveillance (NNIS) guidelines (Pronovost et al., 2006). Infections were determined by culture and validated by hospital infection-control officers. The data was collected by these officers and submitted to researchers once a month. One catheter day was based on the use of one or more central lines per patient per day. For the purpose of data analysis, three months of sequential data was grouped to form quarterly data. Statistical analysis was.....

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