Education and performance feedback effect on rates of central vascular catheter–associated bloodstream infections in adult intensive care units in one hospital in Sao Paulo, Brazil

BACKGROUND: To ascertain the effect of an infection control program utilizing education and performance feedback on intensive care unit (ICU) rates of intravascular device (IVD)-associated bloodstream infection (BSI). METHODS: We studied three Level III adult ICUs of one public hospital in Brazil. All adult patients admitted to the study had a central vascular catheter (CVC) in place for at least 24 hours. A prospective before and after trial in which rates of IVD-associated BSI were determined during a period of active surveillance without education and performance feedback (phase one) were compared to rates of IVD-associated BSI after implementation of an infection control program utilizing education and performance feedback (phase two). Phase one was conducted from October 2003 to February 2004, and phase two was conducted from March 2004 to September 2004. RESULTS: 3280 IVD-days were accumulated during phase one and 4237 IVD-days during phase two. Compliance with handwashing and CVC site care improved from baseline during the study period. Overall rates of IVD-associated BSI were significantly lowered from baseline rates after implementation of education and performance feedback: 14.0 BSI per 1000 CVC days in phase one (46/3280) versus 7.1 BSI per 1000 CVC days in Phase two (30/4237), RR = 0.50, 95% CI = 0.32 – 0.80, p=0.0029). The BSI rate reduction was 50% in 6 months. CONCLUSION: Implementation of an infection control program, utilizing education and performance feedback, resulted in significant reductions in rates of IVD-associated BSI.