Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil

Am J Infect Control. 2005 Mar;33(2):83-7. doi: 10.1016/j.ajic.2004.05.003.


Background: Central venous catheter-associated bloodstream infections (CVC-BSI) are a frequent cause of morbidity and mortality in intensive care settings. Many strategies have been used to decrease the risk of CVC-BSI; however, few studies have explored the educational intervention as an approach to reduce the CVC-BSI rates.

Objective: The purpose of this study was to determine the impact of an educational program targeted to specific points observed during CVC care practices on decreasing CVC-BSI in a medical intensive care unit.

Methods: An educational program was developed by a multidisciplinary task force to highlight correct practices for CVC care. Relative risk ratios, 95% confidence intervals, and P values were determined for all primary and secondary outcomes. The chi 2 linear test for trends of CVC-BSI rates was performed during the study period and the following year.

Results: Forty-eight primary bloodstream infections occurred in 2450 catheter-days (20 per 1000 catheter-days) in the 16 months before the intervention. After the educational intervention and policy changes such as standardized povidone-iodine use during dressing care, the number of CVC-BSI dropped to 16 in 1381 catheter-days (11 per 1000 catheter-days), a decrease of 40%. The rate of CVC-BSI remained almost the same, 22 in 1701 catheter-days (12 per 1000 catheter-days), during the following year after the educational intervention (P = .07). The distribution of pathogens was different comparing the pre- and postintervention period. Staphylococcus aureus was the most common pathogen in preintervention, decreasing significantly during the study period (P = .02). The adhesion to the overall catheter care policy improved significantly in the postintervention period (P < .01).

Conclusion: A multiple approach included an educational strategy, targeted to specific problems observed during a careful evaluation of CVC care practices, and policy changes can decrease rates of CVC-BSI. However, despite the good results, our rates are still high, and reinforcement of CVC care practices will be continued.

Publication types

  • Evaluation Study

MeSH terms

  • Bacteremia / epidemiology*
  • Bacteremia / etiology
  • Bacteremia / prevention & control*
  • Brazil / epidemiology
  • Catheterization, Central Venous / adverse effects*
  • Cross Infection / epidemiology*
  • Cross Infection / etiology
  • Cross Infection / prevention & control*
  • Education, Continuing
  • Hospitals, University
  • Humans
  • Infection Control / methods
  • Infection Control / standards*
  • Intensive Care Units / standards*
  • Organizational Policy
  • Outcome Assessment, Health Care*