Interventional Program in Bacteremia in an Adult ICU of Chilean Teaching Hospital, 9-Year Follow-Up

ISSUE: Bacteremia (BAC) associated with central venous catheters (CVCs) is frequent in critical patients and increases costs and risk of death during hospitalization. The objective of this work was to evaluate results of an interventional program in BAC associated to CVCs in an adult ICU. PROJECT: During 1994–2002, an interventional program in bacteremia was established. It was based in three strategies: 1) inform and discuss the ICU rates of CVC-associated BAC, 2) inform the results of supervision, and 3) educational program to health personnel. Surveillance was done according to NNIS definitions. RESULTS: We surveilled 1799 patients with indwelling CVCs during this period (10,721 catheter days), 54 of them developed BAC (5/1000 catheter day). Average catheterization time was 15.9 days in patients with BAC, compared to 5.7 days in patients without infection (p=0.000764). The rate of CVC-associated BAC between 1994 and 1997 was 7.0 cases/1000 CVC days, which was reduced during 1998–2002 to 3.5 (OR 0.51 IC 0.29–0.87, P=0.018). There where 352 observations done, assessing techniques for insertion and care of CVC. Currently, fulfillment of recommended guidelines to prevent CVC-associated bacteremia is almost 100% for maximal sterile barriers precautions, handwashing, protection and care of insertion site, and connections replacement. CONCLUSION: We observed a significative reduction in the risk of CVC-associated bacteremia as improvement of practices dealing with CVC management was completely fulfilled. Catheterization time is significatively higher in patients with bacteremia.