BMJ  2007;334:362-365 (17 February), doi:10.1136/bmj.39064.457025.DE

Practice

Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach

¹ Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 800 Marshall Street, Slot 512-3, Little Rock, AR 72202, USA , ² Epidemiology and Infection Control, Arkansas Children's Hospital

Abstract

Problem Bloodstream infections associated with catheters were the most common nosocomial infections in one paediatric intensive care unit in 1994-7, with rates well above the national average.

Design Clinical data were collected prospectively to assess the rates of infection from 1994 onwards. The high rates in 1994-7 led to the stepwise introduction of interventions over a five year period. At quarterly intervals, prospective data continued to be collected during this period and an additional three year follow-up period.

Setting A 292 bed tertiary care children's hospital.

Key measures for improvement We aimed to reduce our infection rates to below the national mean rates for similar units by 2000 (a 25% reduction).

Strategies for change A stepwise introduction of interventions designed to reduce infection rates, including maximal barrier precautions, transition to antibiotic impregnated central venous catheters, annual handwashing campaigns, and changing the skin disinfectant from povidone-iodine to chlorhexidine.

Effects of change Significant decreases in rates of infection occurred over the intervention period. These were sustained over the three year follow-up. Annual rates decreased from 9.7/1000 days with a central venous catheter in 1997 to 3.0/1000 days in 2005, which translates to a relative risk reduction of 75% (95% confidence interval 35% to 126%), an absolute risk reduction of 6% (2% to 10%), and a number needed to treat of 16 (10 to 35).

Lessons learnt A stepwise introduction of interventions leading to a greater than threefold reduction in nosocomial infections can be implemented successfully. This requires a multidisciplinary team, support from hospital leadership, ongoing data collection, shared data interpretation, and introduction of evidence based interventions.

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This article has been cited by other articles:

• Kollef, M. (2008). SMART Approaches for Reducing Nosocomial Infections in the ICU. Chest 134: 447-456 [Abstract] [Full text]  
• Costello, J. M., Morrow, D. F., Graham, D. A., Potter-Bynoe, G., Sandora, T. J., Laussen, P. C. (2008). Systematic Intervention to Reduce Central Line-Associated Bloodstream Infection Rates in a Pediatric Cardiac Intensive Care Unit. Pediatrics 121: 915-923 [Abstract] [Full text]  

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Rhys T Lewis
bmj.com, 18 Feb 2007 [Full text]