Infect Chemother.  2010 Aug;42(4):216-222. 10.3947/ic.2010.42.4.216.

Interventions to Prevent Catheter-Associated Blood-stream Infections: A Multicenter Study in Korea

Affiliations
  • 1Department of Family Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.
  • 2Office of Hospital Infection Control, Chonnam National University, Gwangju, Korea.
  • 3Department of Internal Medicine, Chonnam National University, Gwangju, Korea.
  • 4Office of Hospital Infection Control, Korea University Anam Hospital, Seoul, Korea.
  • 5Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
  • 6Office of Hospital Infection Control, Hanyang University Seoul Hospital, Seoul, Korea. paihj@hanyang.ac.kr
  • 7Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea.

Abstract

BACKGROUND
The purpose of this study was to determine the efficacy of infection-control interventions to decrease the incidence of catheter-associated bloodstream infections (CA-BSI) and to examine the sustainability of its effect during and after the intervention in Korea.
MATERIALS AND METHODS
We conducted a prospective multi-strategy intervention in intensive care units (ICUs) at 3 university hospitals in Korea. The intervention consisted of education and on-site training for medical personnel involved in catheter care, active surveillance, and reinforcement of current intervention in each unit. After the intervention of 3 months, we identified CA-BSI cases of each hospital using the electronic database for 6 months.
RESULTS
During the intervention, the number of CA-BSI decreased significantly compared to pre-interventional period (8.7 vs. 2.3 per 1,000 catheter days; rate ratio 0.28; 95% CI, 0.13-0.61). After the intervention, CA-BSI rate increased slightly, but was still significantly lower than that of pre-interventional period (4.3 per 1,000 catheter days; rate ratio, 0.49; 95% CI, 0.31-0.78). Reduction of gram-negative bacterial infections was noted during and after the intervention.
CONCLUSIONS
A multi-strategy approach to reduce CA-BSI could be implemented in diverse settings of medical and surgical units in Korea and decreased CA-BSI rates during the intervention.

Keyword

Catheter-associated bloodstream infections; Healthcare associated infection; Intensive care unit; Intervention

MeSH Terms

Catheters
Electronics
Electrons
Gram-Negative Bacterial Infections
Hospitals, University
Incidence
Intensive Care Units
Korea
Prospective Studies
Reinforcement (Psychology)

Cited by  1 articles

Prevention and treatment of healthcare-associated infections
Mee Soo Chang, Jun Hee Woo
J Korean Med Assoc. 2016;59(8):622-628.    doi: 10.5124/jkma.2016.59.8.622.


Reference

1. Edwards JR, Peterson KD, Andrus ML, Tolson JS, Goulding JS, Dudeck MA, Mincey RB, Pollock DA, Horan TC. NHSN Facilities. National healthcare safety network (NHSN) report, data summary for 2006, issued June 2007. Am J Infect Control. 2007. 35:290–301.
Article
2. Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1994. 271:1598–1601.
Article
3. Digiovine B, Chenoweth C, Watts C, Higgins M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med. 1999. 160:976–981.
Article
4. Smith RL, Meixler SM, Simberkoff MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest. 1991. 100:164–167.
Article
5. Blot S, Vandewoude K, Colardyn F. Nosocomial bacteremia involving Acinetobacter baumannii in critically ill patients: a matched cohort study. Intensive Care Med. 2003. 29:471–475.
Article
6. Rello J, Ochagavia A, Sabanes E, Roque M, Mariscal D, Reynaga E, Valles J. Evaluation of outcome of intravenous catheter-related infections in critically ill patients. Am J Respir Crit Care Med. 2000. 162:1027–1030.
Article
7. Lee SO, Kim S, Lee J, Kim KM, Kim BH, Kim ES, Kim JH, Kim TH, Kim HY, Park SW, Pai H, Uh Y, Lee ES, Jang YS, Chang YJ, Han MJ, Kang JO, Kim MN, Kim MJ, Park ES, Oh HS, Jeong JS, Lee YS, Oh HB, Choi TY. Korean Nosocomial Infections Surveillance System (KONIS). Korean nosocomial infections surveillance system (KONIS) report: Data summary from July through September 2006. Korean J Nosocomial Infect Control. 2006. 11:113–128.
8. Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet. 2000. 355:1864–1868.
Article
9. Lobo RD, Levin AS, Gomes LM, Cursino R, Park M, Figueiredo VB, Taniguchi L, Polido CG, Costa SF. Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil. Am J Infect Control. 2005. 33:83–87.
Article
10. Maas A, Flament P, Pardou A, Deplano A, Dramaix M, Struelens MJ. Central venous catheter-related bacteraemia in critically ill neonates: risk factors and impact of a prevention programme. J Hosp Infect. 1998. 40:211–224.
Article
11. Rosenthal VD, Guzman S, Pezzotto SM, Crnich CJ. Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina. Am J Infect Control. 2003. 31:405–409.
Article
12. Sherertz RJ, Ely EW, Westbrook DM, Gledhill KS, Streed SA, Kiger B, Flynn L, Hayes S, Strong S, Cruz J, Bowton DL, Hulgan T, Haponik EF. Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med. 2000. 132:641–648.
Article
13. Warren DK, Zack JE, Mayfield JL, Chen A, Prentice D, Fraser VJ, Kollef MH. The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU. Chest. 2004. 126:1612–1618.
Article
14. Yoo S, Ha M, Choi D, Pai H. Effectiveness of surveillance of central catheter-related bloodstream infection in an ICU in Korea. Infect Control Hosp Epidemiol. 2001. 22:433–436.
Article
15. Warren DK, Cosgrove SE, Diekema DJ, Zuccotti G, Climo MW, Bolon MK, Tokars JI, Noskin GA, Wong ES, Sepkowitz KA, Herwaldt LA, Perl TM, Solomon SL, Fraser VJ. Prevention Epicenter Program. A multicenter intervention to prevent catheter-associated bloodstream infections. Infect Control Hosp Epidemiol. 2006. 27:662–669.
Article
16. 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. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006. 355:2725–2732.
Article
17. Rosenthal VD, Maki DG, Salomao R, Moreno CA, Mehta Y, Higuera F, Cuellar LE, Arikan OA, Abouqal R, Leblebicioglu H. International Nosocomial Infection Control Consortium. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med. 2006. 145:582–591.
Article
18. Yoo JY, Kim EJ, Yun IS, Lee JS, Lee JY, Byun JM, Ha KH, Yoon SW, Yoon SE, Kang JM. Impact of maximal sterile barrier during the insertion of central venous catheters in adults intensive care units. Korean J Nosocomial Infect Control. 2007. 12:36–41.
19. Jung YJ, Koh Y, Lim CM, Lee JS, Yu MH, Oh YM, Shim TS, Lee SD, Kim WS, Kim DS, Kim WD, Hong SB. The central venous catheter-related infection of chlorhexidine-silver sulfadiazine coated catheters in medical ICU. Tuberc Respir Dis. 2005. 59:389–396.
Article
20. O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for Disease Control and Prevention, U.S. Pediatrics. 2002. 110:e51.
21. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008. 36:309–332.
Article
22. Barrett SP. Infection control in Britain. J Hosp Infect. 2002. 50:106–109.
Article
23. Pronovost P. Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit Project. Am J Infect Control. 2008. 36:S171.
Article
24. Mehta A, Rosenthal VD, Mehta Y, Chakravarthy M, Todi SK, Sen N, Sahu S, Gopinath R, Rodrigues C, Kapoor P, Jawali V, Chakraborty P, Raj JP, Bindhani D, Ravindra N, Hegde A, Pawar M, Venkatachalam N, Chatterjee S, Trehan N, Singhal T, Damani N. Device-associated nosocomial infection rates in intensive care units of seven Indian cities. Findings of the International Nosocomial Infection Control Consortium (INICC). J Hosp Infect. 2007. 67:168–174.
Article
25. Chen YY, Wang FD, Liu CY, Chou P. Incidence rate and variable cost of nosocomial infections in different types of intensive care units. Infect Control Hosp Epidemiol. 2009. 30:39–46.
Article
26. Sitges-Serra A, Hernández R, Maestro S, Pi-Suñer T, Garcés JM, Segura M. Prevention of catheter sepsis: the hub. Nutrition. 1997. 13:Suppl 4. 30S–35S.
Article
27. León C, Alvarez-Lerma F, Ruiz-Santana S, González V, de la Torre MV, Sierra R, León M, Rodrigo JJ. Antiseptic chamber-containing hub reduces central venous catheter-related infection: a prospective, randomized study. Critical Care Medicine. 2003. 31:1318–1324.
Article
Full Text Links
  • IC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr