Reduction of the catheter-associated bloodstream infection rate and an opportunity to improve the quality of care in a long-term acute care hospital

BACKGROUND/OBJECTIVES: A 29-bed long-term acute care hospital (LTCH) that cares for critically ill, but medically stable patients requiring hospitalization for 25 days or more is located in a large tertiary-care hospital. The patient population at LTCH is dominated by those requiring mechanical ventilation and those with debilitating illness requiring a central line for intravenous therapy. Peripherally inserted central catheters (PICC) are the preferred type of intravenous access. For as many as 40%-70% of our patients, their condition is compromised by a previously occurring infection. It is not uncommon for such debilitated patients to carry a combination of two or more resistant organisms necessitating isolation. Most patients arrive with previously inserted central lines. Nearly 75% of the patients arrive with a PICC in place. The other 25% have a PICC inserted near the time of admission. The PICC team is a contracted resource to LTCH. We do not have any control over the insertion procedure, the brand of central lines, the products used for prepping, or the initial dressing used for insertion site. These limitations truly restricted our options and forced us to use our most creative and analytic resources to determine an effective strategy to decrease our bloodstream infection (BSI) rate. After researching the products available on the market for our use, we decided to use a dressing at the insertion site that was impregnated with chlorohexidine gluconate (CHG). METHODS: The Centers for Disease Control and Prevention (CDC) definitions for primary center venous catheter (CVC)-healthcare-associated infections (HAIs) were used. During April 2003, the staff participated in a mandatory inservice on aseptic dressing technique and proper placement of the CHG dressing within 24 hours of admission.