Evidence-based clinical guidelines and their impact on prevention of catheter related blood stream infections

Abstract

The growing concern for hospital-acquired infections in healthcare has stimulated the development of evidence based practice guidelines. Healthcare institutions across the United States are increasing their focus on the implementation of clinical practice guidelines using current evidence based practice. Adherence to these guidelines by healthcare professionals is expected to improve the quality, equity, and efficiency of patient care.

The implementation of a bundle for catheter related blood stream infections (CRBSI) based on the clinical guidelines from the Center for Disease Control and Prevention was initiated in a university hospital's intensive care unit in 2007. Despite the bundle there was a subsequent increase in the incidence of infections in the later part of 2008. A multidisciplinary evaluation of the process included reevaluation and revision of the current unit application of the clinical guidelines based on review of the literature.

This study implemented an education program targeted at the staff nurses in the ICU, evaluating the current literature and evidence based practice approach including a "scrub the hub" component, and it's impact on the incidence of CRBSI. Ongoing tracking of the unit incidence of central line infections 60 days after implementation has revealed a decrease from 4.1 to 2.6/1000 catheter days and no incidence of infection for those 60 days. This is the lowest rate of infection in over 20 months, suggesting a significant response to the intervention.