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Previous Volume 355:2725-2732 December 28, 2006 Number 26 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Wenzel, R. P. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article

ABSTRACT

Background Catheter-related bloodstream infections occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.

Methods We conducted a collaborative cohort study predominantly in ICUs in Michigan. An evidence-based intervention was used to reduce the incidence of catheter-related bloodstream infections. Multilevel Poisson regression modeling was used to compare infection rates before, during, and up to 18 months after implementation of the study intervention. Rates of infection per 1000 catheter-days were measured at 3-month intervals, according to the guidelines of the National Nosocomial Infections Surveillance System.

Results A total of 108 ICUs agreed to participate in the study, and 103 reported data. The analysis included 1981 ICU-months of data and 375,757 catheter-days. The median rate of catheter-related bloodstream infection per 1000 catheter-days decreased from 2.7 infections at baseline to 0 at 3 months after implementation of the study intervention (P0.002), and the mean rate per 1000 catheter-days decreased from 7.7 at baseline to 1.4 at 16 to 18 months of follow-up (P<0.002). The regression model showed a significant decrease in infection rates from baseline, with incidence-rate ratios continuously decreasing from 0.62 (95% confidence interval [CI], 0.47 to 0.81) at 0 to 3 months after implementation of the intervention to 0.34 (95% CI, 0.23 to 0.50) at 16 to 18 months.

Conclusions An evidence-based intervention resulted in a large and sustained reduction (up to 66%) in rates of catheter-related bloodstream infection that was maintained throughout the 18-month study period.

Source Information

From the School of Medicine (P.P., D.N., S.B., S.C., B.S.), the School of Professional Studies in Business and Education (D.S.), and the Bloomberg School of Public Health (H.C.), Johns Hopkins University, Baltimore; and the University of Michigan, Ann Arbor (R.H.); William Beaumont Hospital, Royal Oak (R.W.); Ingham Regional Medical Center, Lansing (G.R.); Harper University Hospital, Detroit (J.B.); Sparrow Health System, Lansing (J.K.); and the Michigan Health and Hospital Association Keystone Center for Patient Safety and Quality, Lansing (C.G.) — all in Michigan.

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Related Letters:

Catheter-Related Bloodstream Infections
Jenny-Avital E. R., Daley M. R., Pronovost P. J., Needham D. M., Berenholtz S.
Extract | Full Text | PDF  
N Engl J Med 2007; 356:1267-1268, Mar 22, 2007. Correspondence

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