Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach. Issue 7589 (15th February 2007)

• Record Type: Journal Article
• Authors: Bhutta, Adnan; Gilliam, Craig; Honeycutt, Michele; Schexnayder, Stephen; Green, Jerril; Moss, Michele; Anand, K J S
• Is Part Of: BMJ. Volume 334:Issue 7589(2007)
• Page Start: 362
• Page End: 365
• Publication Date: 2007-02-15
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Periodicals; 610
• DOI: 10.1136/bmj.39064.457025.DE
• Languages: English
• ISSNs: 0007-1447

Abstract

Abstract : Problem Bloodstream infections associated with catheters were the most common nosocomial infections in one paediatric intensive care unit in 1994-7, with rates well above the national average. Design Clinical data were collected prospectively to assess the rates of infection from 1994 onwards. The high rates in 1994-7 led to the stepwise introduction of interventions over a five year period. At quarterly intervals, prospective data continued to be collected during this period and an additional three year follow-up period. Setting A 292 bed tertiary care children's hospital. Key measures for improvement We aimed to reduce our infection rates to below the national mean rates for similar units by 2000 (a 25% reduction). Strategies for change A stepwise introduction of interventions designed to reduce infection rates, including maximal barrier precautions, transition to antibiotic impregnated central venous catheters, annual handwashing campaigns, and changing the skin disinfectant from povidone-iodine to chlorhexidine. Effects of change Significant decreases in rates of infection occurred over the intervention period. These were sustained over the three year follow-up. Annual rates decreased from 9.7/1000 days with a central venous catheter in 1997 to 3.0/1000 days in 2005, which translates to a relative risk reduction of 75% (95% confidence interval 35% to 126%), an absolute risk reduction of 6% (2% to 10%), and a number needed to treat of 16 (10 to 35). Lessons learnt A stepwise introduction of interventions leading to a greater than threefold reduction in nosocomial infections can be implemented successfully. This requires a multidisciplinary team, support from hospital leadership, ongoing data collection, shared data interpretation, and introduction of evidence based interventions.