A central venous line protocol decreases bloodstream infections and length of stay in a trauma intensive care unit population

Am Surg. 2009 Dec;75(12):1166-70.

Abstract

We evaluated the benefit of a central venous line (CVL) protocol on bloodstream infections (BSIs) and outcome in a trauma intensive care unit (ICU) population. We prospectively compared three groups: Group 1 (January 2003 to June 2004) preprotocol; Group 2 (July 2004 to June 2005) after the start of the protocol that included minimizing CVL use and strict universal precautions; and Group 3 (July 2005 to December 2006) after the addition of a line supply cart and nursing checklist. There were 1622 trauma patients admitted to the trauma ICU during the study period of whom 542 had a CVL. Group 3 had a higher Injury Severity Score (ISS) compared with both Groups 2 and 1 (28.3 +/- 13.0 vs 23.5 +/- 11.7 vs 22.8 +/- 12.0, P = 0.0002) but had a lower BSI rate/1000 line days (Group 1: 16.5; Group 2: 15.0; Group 3: 7.7). Adjusting for ISS group, three had shorter ICU length of stay (LOS) compared with Group 1 (12.11 +/- 1.46 vs 18.16 +/- 1.51, P = 0.01). Logistic regression showed ISS (P = 0.04; OR, 1.025; CI, 1.001-1.050) and a lack of CVL protocol (P = 0.01; OR, 0.31; CI, 0.13-0.76) to be independent predictors of BSI. CVL protocols decrease both BSI and LOS in trauma patients. Strict enforcement by a nurse preserves the integrity of the protocol.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Bacteremia / epidemiology
  • Bacteremia / prevention & control*
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / standards*
  • Clinical Protocols*
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control*
  • Humans
  • Injury Severity Score
  • Intensive Care Units / economics
  • Intensive Care Units / statistics & numerical data
  • Intensive Care Units / trends
  • Length of Stay*
  • Logistic Models
  • Prospective Studies
  • Virginia
  • Wounds and Injuries / economics
  • Wounds and Injuries / therapy*