Subject(s)
Catheterization, Central Venous/adverse effects , Cross Infection/prevention & control , Evidence-Based Medicine , Infection Control/methods , Practice Guidelines as Topic , Administration, Cutaneous , Anti-Infective Agents, Local/administration & dosage , Cause of Death , Chlorhexidine/administration & dosage , Chlorhexidine/analogs & derivatives , Clinical Protocols , Cost of Illness , Cross Infection/economics , Cross Infection/epidemiology , Cross Infection/etiology , Equipment Contamination/prevention & control , Hospitals, Veterans , Humans , Infection Control/standards , Ohio/epidemiology , Risk Factors , Safety Management , Skin Care/methods , Skin Care/standards , Total Quality Management/organization & administration , Universal PrecautionsABSTRACT
BACKGROUND: In 2003, through the Greater Cincinnati Health Council nine health care systems agreed to participate and fund 50% of a two-year project to reduce hospital-acquired infections among patients in intensive care units (ICU) and following surgery (SIP). METHODS: Hospitals were randomized to either the CR-BSI or SIP project in the first year, adding the alternative project in year 2. Project leaders, often the infection control professionals, implemented evidence-based practices to reduce catheter-related blood stream infections (CR-BSIs; maximal sterile barriers, chlorhexidine) at their hospitals using a collaborative approach. Team leaders entered process information in a secure deidentifled Web-based database. RESULTS: Of the four initial sites randomized to CR-BSI reduction, all reduced central line infections by 50% (CR-BSI, 1.7 to 0.4/1000 line days, p < .05). At the project midpoint (3 quarters of 2004), adherence to evidence-based practices increased from 30% to nearly 95%. DISCUSSION: The direct role of hospital leadership and development of a local community of practice, facilitated cooperation of physicians, problem solving, and success. Use of forcing functions (removal of betadine in kits, creation of an accessory pack and a checklist for line insertion) improved reliability. The appropriate floor for central line infections in ICUs is < 1 infection /1,000 line days.
