The impact of bedside behavior on catheter-related bacteremia in the intensive care unit

Arch Surg. 2004 Feb;139(2):131-6. doi: 10.1001/archsurg.139.2.131.


Hypothesis: The success of an educational program in July 1999 that lowered the catheter-related bloodstream infection (CRBSI) rate in our intensive care unit (ICU) 3-fold is correlated with compliance with "best-practice" behaviors.

Design: Before-after trial.

Setting: Surgical ICU in a referral hospital.

Patients: A random sample underwent bedside audits of central venous catheter care (n = 187). All ICU admissions during a 39-month period (N = 4489) were prospectively followed for bacteremia.

Interventions: On the basis of audit results in December 2000, a behavioral intervention was designed to improve compliance with evidenced-based guidelines of central venous catheter management.

Main outcome measures: Compliance with practices known to decrease CRBSI. Secondary outcome was CRBSI rate on all ICU patients.

Results: Multiple deficiencies were identified on bedside audits 18 months after the previous educational program. After the implementation of a separate behavioral intervention in July 2001, a second set of bedside audits in December 2001 demonstrated improvements in documenting the dressing date (11% to 21%; P<.001) and stopcock use (70% to 24%; P<.001), whereas nonsignificant trends were observed in hand hygiene (17% to 30%; P>.99) and maximal sterile barrier precautions (50% to 80%; P =.29). Appropriate practice was observed before and after the behavioral intervention in catheter site placement, dressing type, absence of antibiotic ointment, and proper securing of central venous catheters. Thirty-two CRBSIs occurred in 9353 catheter-days 24 months before the behavioral intervention compared with 17 CRBSIs in 6152 catheter-days during the 15 months after the intervention (3.4/1000 to 2.8/1000 catheter-days; P =.40).

Conclusions: Although a previous educational program decreased the CRBSI rate, this was associated with only modest compliance with best practice principles when bedside audits were performed 18 months later. A behavioral intervention improved all identified deficiencies, leading to a nonsignificant decrease in CRBSIs.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Attitude of Health Personnel
  • Bacteremia / epidemiology
  • Bacteremia / etiology
  • Bacteremia / microbiology
  • Bacteremia / prevention & control*
  • Blood-Borne Pathogens / isolation & purification*
  • Catheters, Indwelling / adverse effects*
  • Catheters, Indwelling / microbiology
  • Cohort Studies
  • Controlled Before-After Studies
  • Cross Infection / prevention & control
  • Education, Medical, Continuing / organization & administration
  • Education, Nursing, Continuing / organization & administration
  • Equipment Contamination / prevention & control*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Intensive Care Units / standards*
  • Male
  • Middle Aged
  • Point-of-Care Systems*
  • Probability
  • Prospective Studies
  • Reference Values
  • Risk Assessment
  • Sex Distribution
  • Statistics, Nonparametric