Eliminating catheter-related bloodstream infections in the intensive care unit

Crit Care Med. 2004 Oct;32(10):2014-20. doi: 10.1097/01.ccm.0000142399.70913.2f.


Objective: To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (CR-BSIs).

Design: Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control ICU.

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 CR-BSIs per 1,000 catheter days from January 1, 1998, 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 ICU decreased from 11.3/1,000 catheter days in the first quarter of 1998 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 1,945,922 dollars 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.

Publication types

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

MeSH terms

  • Catheterization, Central Venous / adverse effects*
  • Catheters, Indwelling / adverse effects*
  • Cohort Studies
  • Critical Care / methods
  • Guideline Adherence
  • Humans
  • Intensive Care Units
  • Practice Guidelines as Topic
  • Prospective Studies
  • Quality Control
  • Quality of Health Care / standards*
  • Sepsis / prevention & control*