| Abstrakt: |
ISSUE: Prevention of central line–associated bacteremia (BSI) has been a priority for the surgical intensive care unit (SICU) of this university hospital, a 570-bed tertiary-care/transplant center. Over the past 8 years, a multidisciplinary team has implemented change and improved outcome in this high-risk population by implementing and monitoring multiple prevention strategies. PROJECT: Nosocomial BSI surveillance was performed by infection control professionals according to Centers for Disease Control and Prevention (CDC) definitions. SICU received quarterly reports of BSI rates and utilization rates. In spite of an algorithm to promote the use of lower-risk vascular devices, central venous catheter (CVL) utilization has significantly increased from 56.27% in 1997, to 100% in 2004, reflecting increased patient acuity. Instituting policy and practice changes in management of lines, based on literature and HICPAC guidelines, and monitoring compliance have been critical in improving outcomes. Education and communication plans were developed for each practice change. Chlorhexidine gluconate (Hibistat®) was used as a site prep in 1997. Total sterile barrier technique was introduced in the mid-1990s, and changes in the CVL insertion tray were made to facilitate compliance with total barrier technique in 1998-99. Initially, non-coated CVLs were used. In June 1998, antimicrobial-impregnated CVLs were introduced. The site prep was switched to Chloroprep® in 2002, which demonstrated a 15% reduction in BSI. After a hospitalwide study, Biopatch® was also added to the regime in 2003, since its use demonstrated a 16% reduction in BSIs. In 2004, the alcohol hand hygiene gel product was changed and wall-mounted dispensers at the bedside and in the hallway were available, in addition to individual bottles. A new medical director also re-emphasized compliance with policy. RESULTS: Constant improvement in patient outcome has been noted over the past 8 years. The CVL– associated BSI/1000 CVL days was 15.51 in 1997 and decreased with the introduction of the multiple new strategies to 4.16 in 2004, even with the utilization rate for CVLs nearly doubling. LESSONS LEARNED: Ongoing implementation of new strategies is important for improving patient outcomes. By making prevention a top priority and continually evaluating and implementing new technologies and recommended practices, a SICU can achieve great reductions in central line–associated infections and approach “the irreducible minimum.” [Copyright &y& Elsevier] |
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