Department of Anesthesiology; Department of Medicine, Division of Infectious Diseases and Immunology; Department of Quantitative Health Sciences
Medical Subject Headings
Catheters, Indwelling; Catheterization, Central Venous; Catheter-Related Infections; Bacteremia
Anesthesiology | Bacterial Infections and Mycoses | Health Services Research | Medicine and Health Sciences | Surgery
Introduction: CRBSI remains a significant problem in the intensive care unit.
Hypothesis: A multimodal approach for the insertion and care of CVC will prevent CRBSI.
Methods: A Critical Care Operations Committee was formed to transform care in 8 intensive care units (ICU) in an academic medical center in 9/2004. One goal was to reduce CRBSI. Using evidence based medicine, a clinical practice guideline was developed that incorporated the use of maximum barrier precautions, chlorhexidine skin preparation, avoidance of the femoral insertion site, dedicated catheter cart, a check list, the tracking of high risk CVC, anti-septic or antimicrobial impregnated catheters, a recommendation to use ultrasound guidance when inserting CVC in the internal jugular vein, daily determination of the need for the CVC and treatment of CRBSI as a critical event.CRBSI were adjudicated by the hospital epidemiologist and CVC days were tracked. Rates of CRBSI were followed from 9/2004 through 7/2011. The Spearman correlation coefficient was used for statistical evaluation. A p
Results: CRBSI rates (per 1000 catheter-days) declined dramatically from 2004 to 2011 (p
Conclusions: A multimodal approach to CVC insertion and care reduces CRBSI by over 90%. Our ultimate goal is the complete eradication of CRBSI in our institution.