| Affiliation: | 1.RIVM National Institute for Public Health and the Environment,Bilthoven,The Netherlands;2.Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich,University of Zurich,Zurich,Switzerland;3.Infection Control and World Health Organization Collaborating Center on Patient Safety,The University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland;4.Division of Anaesthesiology,University ofGeneva Hospitals,Geneva,Switzerland;5.Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg,Freiburg,Germany;6.AZ Sint-Lucas Hospital,Ghent,Belgium;7.University Hospital Galway,Galway,Ireland;8.Medical University of Vienna,Vienna,Austria;9.Pauls Stradins Clinical University Hospital, University of Latvia,Riga,Latvia;10.Department of Infection Control,Institute for Emergency Cardiovascular Diseases “Prof. C.C. Iliescu”,Bucharest,Romania;11.St. Vincent’s University Hospital,Dublin,Ireland;12.University Medical Center Ljubljana,Ljubljana,Slovenia;13.Arnau de Vilanova University Hospital, 25198,Lleida and Vall d’Hebron University Hospital and Universitat Autónoma,Barcelona,Spain;14.Evanggelismos Hospital,Athens,Greece;15.Bács-Kiskun County Teaching Hospital,Kecskemét,Hungary;16.Hospital of Silesia,Cieszyn,Poland;17.Papa Giovanni XXIII Hospital,Bergamo,Italy;18.Office of the Chief Medical Officer and Szent János Hospital,Budapest,Hungary;19.John Paul II Hospital and Dept of Anesthesiology and Intensive Care, Jagielonian University, Medical College,Kraków,Poland;20.John Hopkins University Bloomberg School of Public Health,Baltimore,USA;21.Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg,Freiburg,Germany;22.Imperial College London,London,UK |
| Abstract: | PurposeTo test the effectiveness of a central venous catheter (CVC) insertion strategy and a hand hygiene (HH) improvement strategy to prevent central venous catheter-related bloodstream infections (CRBSI) in European intensive care units (ICUs), measuring both process and outcome indicators.MethodsAdult ICUs from 14 hospitals in 11 European countries participated in this stepped-wedge cluster randomised controlled multicentre intervention study. After a 6 month baseline, three hospitals were randomised to one of three interventions every quarter: (1) CVC insertion strategy (CVCi); (2) HH promotion strategy (HHi); and (3) both interventions combined (COMBi). Primary outcome was prospective CRBSI incidence density. Secondary outcomes were a CVC insertion score and HH compliance.ResultsOverall 25,348 patients with 35,831 CVCs were included. CRBSI incidence density decreased from 2.4/1000 CVC-days at baseline to 0.9/1000 (p < 0.0001). When adjusted for patient and CVC characteristics all three interventions significantly reduced CRBSI incidence density. When additionally adjusted for the baseline decreasing trend, the HHi and COMBi arms were still effective. CVC insertion scores and HH compliance increased significantly with all three interventions.ConclusionsThis study demonstrates that multimodal prevention strategies aiming at improving CVC insertion practice and HH reduce CRBSI in diverse European ICUs. Compliance explained CRBSI reduction and future quality improvement studies should encourage measuring process indicators. |
