Philippe Eggimann, MD; Stéphane Hugonnet, MD, MSc; Hugo Sax, MD; Stephan Harbarth, MD, MS; Jean-Claude Chevrolet, MD; Didier Pittet, MD, MS
Acknowledgments: The authors thank the medical intensive care unit team and the members of the Infection Control Program, in particular M.N. Constantin-Chraïti and S. Touveneau. They also thank Rosemary Sudan for providing editorial assistance.
Grant Support: In part by a research grant from the Swiss National Science Foundation (no. 32-68164.02).
Potential Financial Conflicts of Interest: None disclosed.
Eggimann P., Hugonnet S., Sax H., Harbarth S., Chevrolet J., Pittet D.; Long-Term Reduction of Vascular Access–Associated Bloodstream Infection. Ann Intern Med. 2005;142:875-876. doi: 10.7326/0003-4819-142-10-200505170-00025
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Published: Ann Intern Med. 2005;142(10):875-876.
TO THE EDITOR:
Background: Vascular access–associated infections remain a major complication of modern medicine (1). They increase patient morbidity, affect quality of patient care, and generate substantial hospital costs. Recently revised guidelines (2) have recommended education-based and staff training strategies as first-line prevention measures, but the long-term effect of these strategies has not yet been determined.
Objective: To measure the long-term impact of a multimodal strategy to reduce the incidence of vascular access–associated infections in critical care.
Methods and Findings: Approximately 1500 patients are admitted annually to the 18-bed medical intensive care unit (ICU) of the University of Geneva Hospitals. We conducted prospective on-site surveillance of nosocomial infections according to standardized methods and definitions (3, 4). Primary bloodstream infections included both microbiologically documented bacteremia and clinical sepsis (4). After a 16-month baseline period, we implemented a multimodal strategy targeted at prevention of vascular access infection in early 1997 (3). The intervention involved nurses and physicians and included specific guidelines for vascular access catheter insertion and use, as well as on-site education. Prevention measures were included in the standard of patient care, and all new staff members received specific training. The intervention was not modified during the study period. The institutional review board approved the protocol as a continuous quality improvement project.
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