1. Lindsey, Heather
  2. Chu, Julie MSN
  3. Price, Cynthia

Article Content

According to this study:


* The rate of catheter-related bloodstream infections declined significantly at all facilities as a result of the intervention.


* The diminished rates were maintained for 18 months.


The use of central venous catheters may cause as many as 80,000 bloodstream-related infections and 28,000 deaths in ICU patients annually in the United States, at a cost of as much as $2.3 billion. Empirically conceived interventions are known to prevent many of these infections, and a few individual and multicenter studies have shown that the incidence of catheter-related bloodstream infections can be reduced. These findings have been reinforced by governmental and regulatory initiatives, including the 100,000 Lives Campaign conducted from January 2005 through June 2006 by the Institute for Healthcare Improvement (IHI). Preventing central line infections by using five interventional measures was one of the principal goals of the campaign. In addition, the Centers for Disease Control and Prevention (CDC) issued guidelines on the prevention of catheter-related bloodstream infections in 2002.


Data from 103 Michigan ICUs participating in a statewide safety initiative were collected to determine the extent to which the incidence of catheter-related bloodstream infections could be reduced. Participating ICUs instituted five evidence-based preventive procedures recommended by the CDC (and subsequently by the IHI)--handwashing, using maximum barrier precautions while inserting catheters, using chlorhexidine to clean the skin, selecting the optimal catheter site (subclavian rather than jugular or femoral in nontunneled placement in adults), and removing unnecessary lines. As part of an initiative known as the Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality Keystone ICU project, the researchers sought to assess the effect of the intervention up to 18 months after its implementation.


Conducted between March 2004 and September 2005 with funding provided primarily by the Agency for Healthcare Research and Quality, the study employed several patient-safety interventions, including the catheter-related bloodstream infection intervention. At least one physician and one nurse at each ICU were designated as team leaders and were responsible for disseminating information on safety and the intervention techniques to colleagues, and for assisting local infection-control practitioners in carrying out the intervention and gathering data.


As a result of the intervention effort, the rate of catheter-related bloodstream infections declined significantly-by as much as 66%. At zero to three months, the overall median rate of catheter-related bloodstream infections decreased from 2.7 (mean, 7.7) per 1,000 catheter-days at baseline to zero (mean 2.3) and was kept at zero (mean, 1.4) during the rest of the 18-month follow-up period.


While most other attempts to improve the safety of patients in the United States have been piecemeal, this study's findings suggest that the incidence of catheter-related bloodstream infections and their associated mortality, morbidity, and health care costs can be reduced if the study intervention is introduced nationally or worldwide. It's important to note that, unlike for many other patient-safety issues, congressional funding helped put into place the infrastructure that was needed to staff the study and assemble the data. The study did not involve expensive technology or additional staffing, but state and federal funding and the cooperation of the ICUs were required to train ICU workers to use the intervention. -CP


Pronovost P, et al. N Engl J Med 2006;355(26):2725-32.