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DECREASING CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTIONS: A COMMUNITY HOSPITAL EXPERIENCE

New York Methodist Hospital, Brooklyn, NY

PURPOSE: Central venous catheter-related bloodstream Infections (CRBSI's) are considered among the most preventable class of nosocomial infections. The cost of CRBSI is significant, both in terms of morbidity and expenditure. To improve patient outcome and reduce health care costs, strategies to reduce the incidence of these infections need to be implemented.

METHODS: Our aim for this project was to reduce the CRBSI at New York Methodist Hospital. We used National Nosocomial Infection Surveillance criteria for identification of CRBSI. The infection rate was calculated for 1,000 central venous catheter (CVC) days. Three different strategies were implemented over 2 years which included: 1) restriction of femoral lines, 2) use of maximal barrier precautions, skin sterilization using chlorhexidine, removal of lines at the earliest convenience and 3) use of ultrasound for placement of lines. Data on the number of infections were collected by trained, hospital-based infection control nurses. The data were categorized into three groups; total line infection, femoral line infection and non-femoral line infection. Comparison on rates of CRBSI after each intervention was made among the groups using Poisson regression analysis.

RESULTS: A decrease in incidence-rate ratio after each intervention among all groups was noted. The total line infection rate decreased from 2.5 per 1000 CVC days to 1.0 (p= 0.152) and the femoral line infection rate decreased from 5.5 to 0.0 (p= 0.997) after all the interventions were implemented. Given that the population was small no statistical significance was observed.

CONCLUSION: Our single center multi-interventional study has shown that, CRBSI can be reduced by active interventions like use of maximal barrier precautions, removal of lines at the earliest opportunity, and avoidance of femoral lines. Also noticed was a further reduction in infection rate with use of bedside ultrasound for catheter placement.

CLINICAL IMPLICATIONS: Health care professionals should be aware of different interventions to prevent hospital- acquired infections. We were able to demonstrate that active intervention and teaching can decrease CRBSI in our patient population.

DISCLOSURE: Alexey Amchentsev, No Financial Disclosure Information; No Product/Research Disclosure Information