Eliminating catheter-related bloodstream infections in the intensive care unit

Sean M. Berenholtz, Peter J. Pronovost, Pamela A. Lipsett, Deborah Hobson, Karen Earsing, Jason E. Parley, Shelley Milanovich, Elizabeth Garrett-Mayer, Bradford D. Winters, Haya R. Rubin, Todd Dorman, Trish M. Perl

Research output: Contribution to journalArticle

678 Citations (Scopus)

Abstract

Objective: To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (PR-BSIs). Design: Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control IGU. Setting: The Johns Hopkins Hospital. Patients: All patients with a central venous catheter in the ICU. Intervention: To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed. Measurement: The primary outcome variable was the rate of CH-BSIs per 1,000 catheter days from January 1,1938, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion. Main Results: Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study IGU decreased from 11.3/1,000 catheter days in the first quarter of 1938 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and $1,945,322 in additional costs per year in the study ICU. Conclusions: Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.

Original languageEnglish (US)
Pages (from-to)2014-2020
Number of pages7
JournalCritical Care Medicine
Volume32
Issue number10
DOIs
StatePublished - Oct 1 2004

Fingerprint

Catheter-Related Infections
Intensive Care Units
Catheters
Guidelines
Infection Control
Critical Care
Central Venous Catheters
Quality Improvement
Checklist
Cohort Studies
Nurses
Prospective Studies
Physicians
Costs and Cost Analysis

Keywords

  • Catheterization, central venous
  • Infection, nosocomial
  • Intensive care units
  • Organisational innovation
  • Total quality management

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Berenholtz, S. M., Pronovost, P. J., Lipsett, P. A., Hobson, D., Earsing, K., Parley, J. E., ... Perl, T. M. (2004). Eliminating catheter-related bloodstream infections in the intensive care unit. Critical Care Medicine, 32(10), 2014-2020. https://doi.org/10.1097/01.CCM.0000142399.70913.2F

Eliminating catheter-related bloodstream infections in the intensive care unit. / Berenholtz, Sean M.; Pronovost, Peter J.; Lipsett, Pamela A.; Hobson, Deborah; Earsing, Karen; Parley, Jason E.; Milanovich, Shelley; Garrett-Mayer, Elizabeth; Winters, Bradford D.; Rubin, Haya R.; Dorman, Todd; Perl, Trish M.

In: Critical Care Medicine, Vol. 32, No. 10, 01.10.2004, p. 2014-2020.

Research output: Contribution to journalArticle

Berenholtz, SM, Pronovost, PJ, Lipsett, PA, Hobson, D, Earsing, K, Parley, JE, Milanovich, S, Garrett-Mayer, E, Winters, BD, Rubin, HR, Dorman, T & Perl, TM 2004, 'Eliminating catheter-related bloodstream infections in the intensive care unit', Critical Care Medicine, vol. 32, no. 10, pp. 2014-2020. https://doi.org/10.1097/01.CCM.0000142399.70913.2F
Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Parley JE et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Critical Care Medicine. 2004 Oct 1;32(10):2014-2020. https://doi.org/10.1097/01.CCM.0000142399.70913.2F
Berenholtz, Sean M. ; Pronovost, Peter J. ; Lipsett, Pamela A. ; Hobson, Deborah ; Earsing, Karen ; Parley, Jason E. ; Milanovich, Shelley ; Garrett-Mayer, Elizabeth ; Winters, Bradford D. ; Rubin, Haya R. ; Dorman, Todd ; Perl, Trish M. / Eliminating catheter-related bloodstream infections in the intensive care unit. In: Critical Care Medicine. 2004 ; Vol. 32, No. 10. pp. 2014-2020.
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AU - Hobson, Deborah

AU - Earsing, Karen

AU - Parley, Jason E.

AU - Milanovich, Shelley

AU - Garrett-Mayer, Elizabeth

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