DEVELOPMENT OF BEST PRACTICES REDUCES CENTRAL VENOUS CATHETER (CVC) INFECTION RATE: Supplemental 532

Introduction:
CVC infections in ICU patients represent significant morbidity and cost to patients and institutions.

Hypothesis:
Can education and the development of a Best Practices protocol reduce CVC infection rate and associated costs?

Methods:
We conducted a retrospective review of 6-month periods before and after implementation of Best Practices in a 40-bed Cardiovascular Intensive Care Unit (CVICU). A team of Intensivists, ICU nurses, and Infection Control representatives reviewed national and local guidelines to develop a CVC Management Best Practices protocol. An intense education campaign targeted all levels of CVICU caregivers. Evaluation of Daily Goals for each patient identified the continued need for central venous access. The bedside nurse completed an audit form each time a CVC was inserted. CVC infection rates from January through June 2003 were compared with January through June 2004. Infections were identified using the National Nosocomial Infections Surveillance definitions.

Results:
We demonstrated a decrease in the CVC-associated infection rate in our CVICU. The overall infection rate was 3.5 infections per 1000 CVC days for the six month period in 2003 and fell to 1.4 in 2004. These rates represent a total of 21 infections in 2003 and 8.4 infections in 2004. Assuming that one CVC infection costs $27,000 and that 12.6 CVC infections were avoided, the estimated cost savings is $340,200 in 6 months.

Conclusions:
Using Best Practices for CVC management and ongoing education of caregivers, led by a team of Intensivists, reduces CVC infection rate with substantial associated cost savings.