N Engl J Med. 2006 Dec 28;355(26):2725-32.
Erratum in:
N Engl J Med. 2007 Jun 21;356(25):2660.
Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B,
Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C.
School of Medicine, Johns Hopkins University, Baltimore, USA
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 (P< or =0.002), 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. Copyright
2006 Massachusetts Medical Society.