BSI Prevention Project PI: Trish M. Perl, MD, Msc & Sara Cosgrove, MD, MS; Sponsor: Centers for Disease Control and Prevention (CDC)

Central venous catheters have become indispensable in the care of critically ill patients and have made the modern discipline of critical care medicine possible. As the severity of illness and complexity of therapeutic measures in the intensive care unit (ICU) setting has increased, the chance for complications from the use of medical devices has increased, the most serious of which is infection. Catheter-related bloodstream infection (CRBSI) is one of the most common nosocomial infections in ICU patients. Catheter-related bloodstream infections have been estimated to occur in 3 to 7% of catheters used, and affect more than 200,000 patients in the United States annually. Previous studies have shown nosocomial bloodstream infections to be associated with increased attributable mortality, length of hospital stay, and cost.

Prevention of nosocomial infections is primarily a function of hospital infection control programs. Several modifiable factors have been shown to increase the risk of catheter-related bloodstream infection. These include lapses in the use of strict sterile technique in the insertion of central venous catheters and insertion of catheters into internal jugular or femoral vein sites, compared to the subclavian vein. In 1996, the CDC developed guidelines for the prevention of intravascular device-related nosocomial infections. In these guidelines, the CDC strongly recommended the “ongoing education and training of health care workers regarding… procedures for the insertion and maintenance of intravascular devices and appropriate infection control measures to prevent intravascular device-related infections.”

Surveillance Protocol for the Evaluation of Catheter-associated Bloodstream Infections (CABSI) and Central Venous Catheter Insertion Site Care

The purpose of this part of the above multicenter study is to determine the incidence of catheter-associated bloodstream infections and the processes of central venous catheter site care among hospitalized patients. This surveillance will include regular observations of central venous catheter insertion sites, plus daily determinations of patient census and total number of catheterized patients. Also, microbiologic data will be reviewed on patients admitted to study units to determine the presence of catheter-associated bloodstream infection. This study is the first part of a larger project, BSI Prevention Project, which purposes to determine if an educational intervention based on CDC guidelines can be implemented throughout multiple hospitals in various regions of the United States. This surveillance data will be used to determine the effectiveness of an intervention designed to reduce the incidence of catheter-associated bloodstream infections. Surveillance data will be collected from 1/1/02 through 12/31/03. This data will establish baseline and post-intervention BSI rates in the units involved.

The impact of an intervention designed to reduce the incidence of nosocomial catheter-associated bloodstream infections.

Hypothesis: An educational intervention, aimed at changing the process of central venous catheter insertion and care, based on CDC guidelines to prevent catheter-associated bloodstream infections, can be successfully implemented within multiple intensive care units within a multicenter framework. Secondarily, this intervention may result in a significant reduction in the incidence of catheter-associated bloodstream infections within these units.

Staff education module: A standard, self-study, educational module on the prevention of catheter-associated bloodstream infection with pre- and post-tests will be used as the primary educational tool. This would be administered to all nurses in the study units and all housestaff, fellow, and attending physicians within the intervention period (7/1/2002- 9/30/2002). The module will be accompanied by in-service sessions for nursing and a didactic slide presentation for physicians.

Posters/ Fact sheets: Posters highlighting proper central venous catheter insertion and care techniques will be placed in areas where they can be viewed by unit personnel.

Central venous catheter insertion checklist: A checklist of the process of central venous catheter insertion (type of catheter, anatomic insertion site, prep used, etc.) will be completed for all catheters inserted in the study units by unit nursing staff. The purpose of this checklist is to reinforce proper central line insertion technique in the post-intervention period. The checklists will be collected on a regular basis from the study units.