Effectiveness of stepwise interventions targeted to decrease central catheter-associated bloodstream infections.

OBJECTIVE Determine the impact of three stepwise interventions on the rate of central catheter-associated bloodstream infections. DESIGN Quasi-experimental study. SETTING Three surgical intensive care units (general surgery, trauma, and neurosurgery) at a 1500-bed county teaching hospital in the Miami metro area. PATIENTS All consecutive central catheter-associated bloodstream infection cases as determined by the Infection Control Department. INTERVENTIONS Three interventions aimed at catheter maintenance were implemented at different times in the units: chlorhexidine "scrub-the-hub," chlorhexidine daily baths, and daily nursing rounds aimed at assuring compliance with an intensive care unit goal-oriented checklist. MEASUREMENTS AND MAIN RESULTS The primary outcome was the monthly intensive care unit rate of central catheter-associated bloodstream infections (infections per 1000 central catheter days). Over 33 months of follow-up (July 2008 to March 2011), we found decreased rates in each of the three intensive care units evaluated during the interventions, especially after implementation of chlorhexidine daily baths. Rates in unit A decreased from a rate of 8.6 to 0.5, unit B from 6.9 to 1.6, and unit C from 7.8 to 0.6. Secondary bloodstream infection rates remained unchanged throughout the observation period in units A and B; however, unit C had a decrease in its rates over time. CONCLUSIONS We report the progressive reduction of central catheter-associated bloodstream infection rates after the stepwise implementation of chlorhexidine "scrub-the-hub" and daily baths in surgical intensive care units, suggesting effectiveness of these interventions.