Preventing Central Venous Catheter—Associated Primary Bloodstream Infections: Characteristics of Practices Among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) Study

• Published in: Infection control and hospital epidemiology Vol. 24; no. 12; pp. 926 - 935
• Main Authors: Braun, Barbara I., Kritchevsky, Stephen B., Wong, Edward S., Solomon, Steve L., Steele, Lynn, Richards, Cheryl L., Simmons, Bryan P.
• Format: Journal Article
• Language: English
• Published: Thorofare, NJ The University of Chicago Press 01-12-2003; Slack; Cambridge University Press
• Subjects: Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - instrumentation; Catheters, Indwelling - microbiology; Central venous catheterization; Cross Infection - epidemiology; Cross Infection - etiology; Cross Infection - prevention & control; Epidemiology; Health Care Surveys; Hospital units; Hospitals; Human bacterial diseases; Humans; Infection control; Infection Control - methods; Infection Control - organization & administration; Infections; Infectious diseases; Intensive care units; Intensive Care Units - manpower; Medical instruments; Medical practice; Medical sciences; Nurses; Nursing; Nursing Staff, Hospital - supply & distribution; Observational studies; Organizational Policy; Original Articles; Personnel Staffing and Scheduling; Process Assessment (Health Care); Prospective Studies; Public health. Hygiene-occupational medicine; Registered nurses; Sepsis - epidemiology; Sepsis - etiology; Sepsis - prevention & control; Staffing; United States - epidemiology; United States; Human; Nosocomial infection; Primary infection; Characteristic; Catheter; Check; Bacteremia; Indicator; Central vein; Infection; Prevention; Bacteriosis; Hospital; Public health
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/502161

To describe the conceptual framework and methodology of the Evaluation of Processes and Indicators in Infection Control (EPIC) study and present results of CVC insertion characteristics and organizational practices for preventing BSIs. The goal of the EPIC study was to evaluate relationships among processes of care, organizational characteristics, and the outcome of BSI.
This was a multicenter prospective observational study of variation in hospital practices related to preventing CVC-associated BSIs. Process of care information (eg, barrier use during insertions and experience of the inserting practitioner) was collected for a random sample of approximately 5 CVC insertions per month per hospital during November 1998 to December 1999. Organization demographic and practice information (eg, surveillance activities and staff and ICU nurse staffing levels) was also collected.
Medical, surgical, or medical-surgical ICUs from 55 hospitals (41 U.S. and 14 international sites).
Process information was obtained for 3,320 CVC insertions with an average of 58.2 (+/- 16.1) insertions per hospital. Fifty-four hospitals provided policy and practice information.
Staff spent an average of 13 hours per week in study ICU surveillance. Most patients received nontunneled, multiple lumen CVCs, of which fewer than 25% were coated with antimicrobial material. Regarding barriers, most clinicians wore masks (81.5%) and gowns (76.8%); 58.1% used large drapes. Few hospitals (18.1%) used an intravenous team to manage ICU CVCs.
Substantial variation exists in CVC insertion practice and BSI prevention activities. Understanding which practices have the greatest impact on BSI rates can help hospitals better target improvement interventions.