Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T00:49:33.679Z Has data issue: false hasContentIssue false
  • English
  • Français

Preventing Central Venous Catheter-Associated Primary Bloodstream Infections: Characteristics of Practices Among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) Study

Published online by Cambridge University Press:  02 January 2015

Barbara I. Braun ,
Stephen B. Kritchevsky ,
Edward S. Wong ,
Steve L. Solomon ,
Lynn Steele ,
Cheryl L. Richards ,
Bryan P. Simmons  and
Evaluation of Processes and Indicators in Infection Control (EPIC) Study Group
Barbara I. Braun*
Affiliation:
Division of Research, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois
Stephen B. Kritchevsky
Affiliation:
Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
Edward S. Wong
Affiliation:
Infectious Disease Section, McGuire Veterans Affairs Medical Center and, Medical College of Virginia, Richmond, Virginia
Steve L. Solomon
Affiliation:
Division of Healthcare Quality PromotionCenters for Disease Control and Prevention, Atlanta, Georgia
Lynn Steele
Affiliation:
Division of Healthcare Quality PromotionCenters for Disease Control and Prevention, Atlanta, Georgia
Cheryl L. Richards
Affiliation:
Division of Research, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois
Bryan P. Simmons
Affiliation:
Quality Management, Methodist Health Systems, Memphis, Tennessee
*
Division of Research, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Boulevard, Oakbrook Terrace, IL 60181
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To describe the conceptual framework and methodology of the Evaluation of Processes and Indicators in Infection Control (EPIC) study and present results of CVC insertion characteristics and organizational practices for preventing BSIs. The goal of the EPIC study was to evaluate relationships among processes of care, organizational characteristics, and the outcome of BSI.

Design:

This was a multicenter prospective observational study of variation in hospital practices related to preventing CVC-associated BSIs. Process of care information (eg, barrier use during insertions and experience of the inserting practitioner) was collected for a random sample of approximately 5 CVC insertions per month per hospital during November 1998 to December 1999. Organization demographic and practice information (eg, surveillance activities and staff and ICU nurse staffing levels) was also collected.

Setting:

Medical, surgical, or medical-surgical ICUs from 55 hospitals (41 U.S. and 14 international sites).

Participants:

Process information was obtained for 3,320 CVC insertions with an average of 58.2 (± 16.1) insertions per hospital. Fifty-four hospitals provided policy and practice information.

Results:

Staff spent an average of 13 hours per week in study ICU surveillance. Most patients received nontunneled, multiple lumen CVCs, of which fewer than 25% were coated with antimicrobial material. Regarding barriers, most clinicians wore masks (81.5%) and gowns (76.8%); 58.1% used large drapes. Few hospitals (18.1%) used an intravenous team to manage ICU CVCs.

Conclusions:

Substantial variation exists in CVC insertion practice and BSI prevention activities. Understanding which practices have the greatest impact on BSI rates can help hospitals better target improvement interventions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 926 - 935
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Society for Healthcare Epidemiology of America (SHEA) member epidemiologists and liaisons from hospitals participating in the EPIC process assessment component included Diane Baranowsky, RN; Sue Barnett; Sandi Baus, RN, CIC, MBA; Jacqueline Berry, RN; Terri Bethea, BSN; Gregory Bond, MSN, RN, CIC; Barbara Bor, RN; Diann Boyette, RN; Jacqueline P. Butler, CIC, MLT (ASCP); Ruth Carrico, PhD, RN, CIC; Janine Chapman, RN, BSN; Gwen Cunningham, RN, BSN, CIC; Mary Dahlmann; Elizabeth DeHaan; Mario Javier DeLuca, MD; Richard J. Duma, MD, PhD; LeAnn Ellingson, RN, BSN, CIC; Jeffrey Engel, MD; Pam Falk, MPH; W. Lee Fanning, MD; Christine Filippone; Brenda Grant, RN; Bonnie Greene, MLT (ASCP), SSH; Robert Grisnak, RN; Peg Janasie; Carol Jarvis, CIC; Stuart Johnson, MD; Najwa A. Khuri-Bulos, MD; Joan Kies, RN; Mary J. K. Kim, MSPH, CIC; Brian Koll, MD; Kenji Kono, MD; Wesley Kozinn, MD; Mary Kundus, RN, CIC; Jane Lane, RN; James W. Lederer, MD; Francis J. G. Liu, MD; Carlo Marena, MD, PhD; Linda Matrician, RN, CIC; Jean Maurice, RN; Malkanthie I. McCormick, MD; Clifford McDonald, MD; Gerry Mcllvenny; Kelley Melton, BS, RN, CIC; Ziad A. Memish, MD; Juan Menares, MD; Leonard Mermel, DO, SCM; Paul M. Newell, MD; Catherine O'Neill, RN; Chik Hyun Pai, MD, PhD; Steve Parenteau, MT (ASCP), MS; Michael F. Parry, MD; Cresio Romeu Pereira, MD, MSC; Robert L. Pinsky, MD; Didier Pittet, MD, MS; Jerome Robert, MD; Debra A. Runyan; Barbara Russell, RN, MPH, ACRN, CIC; Ann Schlimm, RN; Jacquelyn Seibert, RN; G. Merrill Shore, MD; Claudia Vallone Silva, RN; Bryan Simmons, MD; Marjeta Skerl, MD; Edward T. M. Smyth, MD; Alice Stankus, RN, CIC; Connie Steed, RN, BSN, CIC; Christopher J. Sullivan, MD; Joseph R. Thurn, MD, MPH; Martin Topiel, MD; Antoni Trilla, MD, PhD; Prity L. Vaidya, MD; Bonnie Viergutz, RN, CIC; Merceditas S. Villanueva, MD; Carol Ward, RN, CIC; Chatrchai Watanakunakorn, MD; Stefan Weber, MD, MS; Sharon Welbel, MD; Donna Winborne, RN, BSN; Mary Wisniewski, RN, MSN; Edward Wong, MD; and Kathryn Zink.

References

1. O'Grady, NP, Alexander, M, Dellinger, EP, et al. Draft Guideline for the Prevention of Intravascular Catheter-Related Infections. Atlanta, GA Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion; 2001. Available at http://www.cdc.gov/ncidod/hip/IV/Draft_IV_Guideline.pdf. Accessed November 2, 2001.Google Scholar
2. Wenzel, RP, Edmund, MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis 2001;7:174–177.Google Scholar
3. Baine, WB, Yu, W, Summe, JP. The epidemiology of hospitalization of elderly Americans for septicemia or bacteremia in 1991-1998: application of Medicare claims data. Ann Epidemiol 2001;11:118–126.Google Scholar
4. Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.10.1017/S019594170000480XGoogle Scholar
5. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1990-May 1999, issued June 1999. Am J Infect Control 1999;27:520–532.Google Scholar
6. Solberg, LI, Mosser, G, McDonald, S. The three faces of performance measurement: improvement, accountability, and research. Jt Comm J Qual Improv 1997;23:135–147.Google Scholar
7. Kritchevsky, SB, Braun, BI, Wong, ES, et al. Impact of hospital care on incidence of bloodstream infection: the evaluation of processes and indicators in infection control study. Emerg Infect Dis 2001;7:193–196.10.3201/eid0702.010207Google Scholar
8. Donabedian, A. The definitions of quality and approaches to its assessment. In: Explorations in Quality Assessment and Monitoring, vol. 1. Ann Arbor, MI: Health Administration Press; 1980:79, 81.Google Scholar
9. Mermel, LA. Defining intravascular catheter-related infections: a plea for uniformity. Nutrition 1997;13(suppl 4):2S–4S.Google Scholar
10. Emori, TG, Culver, DG, Horan, TC, et al. National Nosocomial Infections Surveillance System (NNIS) : description of surveillance methods. Am J Infect Control 1991;19:19–35.Google Scholar
11. Mermel, LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000;132:391–401.Google Scholar
12. Meyer, GS, Massagli, MP. The forgotten component of the quality triad: can we still learn something from “structure”? Jt Comm J Qual Improv 2001;27:484–493.Google Scholar
13. Sainfort, F, Karsh, BT, Booske, BC, Smith, MJ. Applying quality improvement principles to achieve healthy work organizations. Jt Comm J Qual Improv 2001;27:469–482.Google Scholar
14. Eisenberg, JM, Bowman, CC, Foster, NE. Does a healthy health care workplace produce higher-quality care? Jt Comm J Qual Improv 2001;27:444–454.Google Scholar
15. Maki, DG, Stolz, SM, Wheeler, S, Mermel, LA. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. Ann Intern Med 1997;127:257–266.10.7326/0003-4819-127-4-199708150-00001Google Scholar
16. Meier, PA, Fredrickson, M, Carney, M, Nettleman, MD. Impact of a dedicated intravenous therapy team on nosocomial bloodstream infection vates . J Infect Control 1998;26:388–392.10.1016/S0196-6553(98)70033-1Google Scholar
17. Hoffman, KK, Weber, DJ, Samsa, GP, Rutala, WA. Transparent Polyurethane film as an intravenous catheter dressing: a meta-analysis of the infection risks. JAMA 1992;267:2072–2076.Google Scholar
18. Polderman, KH, Girbes, ARJ. Central venous catheter use: Part 2. Infectious complications. Intensive Care Med 2002;28:18–28.10.1007/s00134-001-1156-7Google Scholar
19. Fridkin, SK, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17:150–158.Google Scholar
20. Robert, J, Fridkin, SK, Blumberg, HM, et al. The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit. Infect Control Hosp Epidemiol 2000;21:12–17.Google Scholar
21. Dorsey, G, Borneo, HT, Sun, SJ, et al. A heterogeneous outbreak of Enterobacter cloacae and Serratia marcescens infections in a surgical intensive care unit. Infect Control and Hosp Epidemiol 2000;21:465–469.Google Scholar
22. Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP, the NNIS System. Nosocomial infections in medical intensive care units in the United States. Crit Care Med 1999;27:887–892.Google Scholar
23. Brun-Buisson, C, Doyon, F, Carlet, J, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults: a multicenter prospective studying intensive care units. JAMA 1995;274:968–974.Google Scholar
24. Ansari, MZ, Collopy, BT. Nosocomial infection indicators in Australian hospitals: assessment according to hospital characteristics. Journal of Quality in Clinical Practice 1997;17:73–82.Google Scholar
25. Gastmeier, P, Schumacher, M, Daschner, R, Ruden, H. An analysis of two prevalence surveys of nosocomial infection in German intensive care units. J Hosp Infect 1997;35:97–105.Google Scholar
26. Jamulitrat, S, Meknavin, U, Thongpiyapoom, S. Factors affecting mortality outcome and risk of developing nosocomial bloodstream infection. Infect Control Hosp Epidemiol 1994;15:163–170.Google Scholar
27. Wenzel, RP, ed. Prevention and Control of Nosocomial Infections, ed. 2. Baltimore: Williams and Wilkius; 1993:540–543.Google Scholar
28. Kritchevsky, SB, Braun, BI, Gross, PA, Newcomb, CS, Kelleher, CA, Simmons, BS. Definition and adjustment of Cesarean section rates and assessments of hospital performance. Int J Qual Health Care 1999;11:283–291.Google Scholar
29. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance System (NNIS) report: semiannual report, from January 1995-November 2000, issued December 2000. Available at http://www.cdc.gov/ncidod/hip/NNIS/DEC2000sar.PDF. Accessed March 23, 2001.Google Scholar
30. Randolph, AG, Guyatt, GH, Carlet, J. Understanding articles comparing outcomes among intensive care units to rate quality of care. Crit Care Med 1998;26:773–781.Google Scholar
31. American Hospital Association. AHA Guide to the Health Care Field, 2000-2001 Edition. Chicago: American Hospital Association; 2001.Google Scholar
32. American Hospital Association. Hospital Statistics, 2001 Edition. Chicago: American Hospital Association; 2001:4.Google Scholar
33. Clemence, MA, Walker, D, Farr, BM. Central venous catheter practices: results of a survey. Am J Infect Control 1995;23:5–12.Google Scholar
34. Girouard, S, Levine, G, Goodrich, K, et al. Infection control programs at children's hospitals: a description of structures and process. Am J Infect Control 2001;29:145–151.Google Scholar
35. Murphy, CL, McLaws, ML. Methodologies used in surveillance of surgical wound infections and bacteremia in Australian hospitals. Am J Infect Control 1999;27:474–481.Google Scholar
36. Scheckler, WE, Brimhall, D, Buck, AS, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Am J Infect Control 1998;26:47–60.Google Scholar