Eliminating catheter-related bloodstream infections in the intensive care unit

被引:636
作者
Berenholtz, SM [1 ]
Pronovost, PJ
Lipsett, PA
Hobson, D
Earsing, K
Farley, JE
Milanovich, S
Garrett-Mayer, E
Winters, BD
Rubin, HR
Dorman, T
Perl, TM
机构
[1] Johns Hopkins Univ, Sch Med, Dept Anesthesiol CCM, Ctr Innovat Qual Patient Care, Baltimore, MD USA
[2] Johns Hopkins Univ, Sch Med, Dept Surg, Ctr Innovat Qual Patient Care, Baltimore, MD 21205 USA
[3] Johns Hopkins Univ, Sch Med, Dept Hlth Policy & Management, Ctr Innovat Qual Patient Care, Baltimore, MD 21205 USA
[4] Johns Hopkins Univ, Sch Med, Dept Nursing, Baltimore, MD 21205 USA
[5] Johns Hopkins Univ Hosp, Dept Surg, SICU, Baltimore, MD 21287 USA
[6] Johns Hopkins Univ Hosp, Dept Hosp Epidemiol & Infect Control, Baltimore, MD 21205 USA
[7] Johns Hopkins Univ, Sch Med, Dept Oncol, Baltimore, MD 21205 USA
[8] Johns Hopkins Univ, Sch Med, Dept Med, Bloomberg Sch Publ Hlth, Baltimore, MD 21205 USA
[9] Johns Hopkins Univ, Sch Med, Dept Hlth Policy & Management, Bloomberg Sch Publ Hlth, Baltimore, MD 21205 USA
[10] Ctr Innovat Qual Patient Care, Baltimore, MD USA
[11] Johns Hopkins Univ Hosp, Dept Anesthesiol CCM, Baltimore, MD 21287 USA
[12] Johns Hopkins Univ Hosp, Dept Med, Baltimore, MD 21287 USA
[13] Johns Hopkins Univ Hosp, Dept Nursing, Baltimore, MD 21287 USA
[14] Johns Hopkins Univ, Sch Med, Dept Hosp Epidemiol & Infect Control, Baltimore, MD USA
关键词
intensive care units; infection; nosocomial; catheterization; central venous; total quality management; organizational innovation;
D O I
10.1097/01.CCM.0000142399.70913.2F
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (CR-BSIs). Design: Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control ICU. Setting: The Johns Hopkins Hospital. Patients: All patients with a central venous catheter in the ICU. Intervention: To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed. Measurement: The primary outcome variable was the rate of CR-BSIs per 1,000 catheter days from January 1, 1998, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion. Main Results: Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study ICU decreased from 11.3/1,000 catheter days in the first quarter of 1998 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and $1,945,922 in additional costs per year in the study ICU. Conclusions: Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.
引用
收藏
页码:2014 / 2020
页数:7
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