Intravenous literature: Freixas, N., Bella, F., LimÃ³n, E., Pujol, M., Almirante, B. and Gudiol, F. (2012) Impact of a multimodal intervention to reduce bloodstream infections related to vascular catheters in non-ICU wards: a multicentre study. Clinical Microbiology and Infection. Sep 20. [Epub ahead of print].
To determine the impact of a multimodal intervention designed to reduce the incidence of catheter-related bloodstream infections (CRBSIs) outside the ICU, we conducted a prospective, quasi-experimental, before-after intervention study in 11 hospitals participating in the VINCat programme in Catalonia, Spain. The intervention consists of: (i) an evidence-based bundle of practices relating to catheter insertion and maintenance; (ii) a training programme for healthcare workers; (iii) four point-prevalence surveys to track the status of the catheters; and (iv) feedback reports to the staff involved. The study included both central (CVC) and peripheral venous catheters (PVCs). Rates of CRBSI per 1000 patient-days were prospectively measured in 2009 (pre-intervention period) and 2010 (post-intervention period). The analysis included 1â€ƒ191â€ƒ843 patient-days in 2009 and 1â€ƒ173â€ƒ672 patient-days in 2010. The overall incidence of CRBSI decreased from 0.19 to 0.15 (pâ€ƒ0.04) and the incidence of CRBSI associated with a CVC decreased from 0.14 to 0.10 (pâ€ƒ0.004) after the intervention. The incidence in PVCs remained unchanged. There was a statistically significant improvement in the adequate maintenance of both CVCs and PVCs. Among the CRBSIs originating in PVCs, 61.8% appeared more than 72â€ƒh every insertion. There was a lower infection rate in the hospitals with a higher adherence to the recommendation to replace PVCs after 72â€ƒh. Our findings suggest that the implementation of intervention programmes similar to ours could have a major impact on patient safety by reducing the incidence of CRBSIs, and that routine replacement of PVCs might additionally prevent a significant number of bloodstream infections.