Main Menu Browse by Day or Program Author Keywords

923 A multicenter educational intervention for prevention of CVC-associated Sepsis

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Sonja Hansen, MD, MPH , Institute of Hygiene; Charité - University Medicine Berlin, Berlin, Germany
Frank Schwab, PhD , Institute of Hygiene; Charité - University Medicine Berlin, Berlin, Germany
Sandra Schneider, MD , Institute of Hygiene; Charité - University Medicine Berlin, Berlin, Germany
Dorit Sohr, PhD , Institute of Hygiene; Charité - University Medicine Berlin, Berlin, Germany
Petra Gastmeier, MD , Institute of Hygiene; Charité - University Medicine Berlin, Berlin, Germany
Christine Geffers, MD , Institute of Hygiene; Charité - University Medicine Berlin, Berlin, Germany
Background:

Central venous catheter (CVC)-associated bloodstream infections (BSI) remain a major complication in intensive care units (ICUs).
Objective:

To evaluate the influence of a structured multimodal intervention programme on the CVC-BSI rate of 32 ICUs in Germany.

Methods:

ICUs of the “Krankenhaus Infektions Surveillance System” (KISS) showing a CVC-BSI rate above the median were asked for implementation of a 12 months  centrally organized educational intervention programme starting in April 2007.
The educational intervention included specific evidence based recommendations for CVC insertion and CVC management. It was addressed to ICU staff involved in CVC use. Modules were advanced training, script and posters. Modules’ content was composed and distributed according to the “train the trainer” principle by the KISS team.
Infection rates were calculated before (April 2006 - March 2007) during (April 2007 - March 2008) and one year after intervention (April 2008 - March 2009).
Results:
38 ICUs participated in the study. Complete data of 32 ICUs could be analyzed. Analyzed ICUs had a median of 11 beds and 8 ventilator beds. The majority of ICUs (52%) was affiliated to teaching hospitals; 26% were affiliated to university hospitals. Altogether 203,111 CVC-days and 397 cases of CVC-associated sepsis were analyzed. Before the implementation the baseline pooled mean CVC-BSI rate was 2.3 CVC-BSI per 1000 CVC-days. At the end of the intervention period a decrease of the mean CVC-BSI rate was observed whereas a significant decrease could be shown during the follow up period. The progress of the CVC-BSI rate is shown in table 1.
Table 1: Infection rates before, during and one year after the educational intervention

 

CVC-days (n)

Cases of

CVC-ass. sepsis (n)

 Pooled CVC-ass. sepsis rate

Relative Risk (RR)(95CI)

Baseline (4/06-3/07)

  69 828 160 2.3  =Reference value

During intervention period (4/07-3/08)

  67 960 137 2.0 0.88 (0.70 - 1.11)
One year follow up (4/08-3/09)  65 323 100 1.5 0.67 (0.52 - 0.86)

Conclusions: Centrally organized multimodal intervention programmes in addition to ongoing surveillance activities lead to a significant decrease of CVC-associated BSI rates in ICUs with infection rates above average.