Prevención de la bacteriemia relacionada con catéteres en UCI mediante una intervención multifactorial. Informe del estudio piloto / Prevention of bacteriema related with ICU catheters by multifactorial intervention: A report of the pilot study

Objetivo: Evaluar la aplicabilidad a nivel nacional de las intervenciones propuestas en el estado de Michigan por Peter Pronovost et al para la prevención de B-CVC en pacientes ingresados en UCI. Diseño: Estudio piloto, prospectivo y comparativo. Ámbito: Han participado 18 UCI (nueve control y nueve intervención) de tres comunidades autónomas de España a lo largo de tres meses en el año 2007. Intervención Incluyó las actividades siguientes: a) programa de formación del personal sanitario; b) introducción de medidas específicas relacionadas con la inserción y manejo de los CVC (lista de comprobación durante la inserción de los CVC, carro exclusivo para accesos venosos, cartel informativo con los cinco procedimientos propuestos para disminuir las bacteriemias: higiene de manos, uso de barreras asépticas máximas durante la inserción, asepsia de la piel del punto de inserción con clorhexidina, evitar la vía de acceso femoral y retirar todos los CVC innecesarios, y c) medidas dirigidas a promover la cultura de seguridad en el trabajo diario (objetivos diarios, aprender de los errores, rondas de seguridad). Resultados: La tasa de B-CVC expresada en medias ha disminuido a la mitad en comparación con los registros históricos. Se identificaron diferentes problemas en la implantación de las medidas específicas relacionadas con los catéteres y en las herramientas de seguridad. Conclusiones: El proyecto de intervención evaluado en el estudio piloto puede ser viable a nivel nacional. Es necesario modificar y adaptar a la realidad española las herramientas propuestas (AU)

Objective: To assess the applicability on a national level of the interventions proposed by Peter Pronovost et al in Michigan state for the prevention of central vascular catheter-related bacteremia (B-CVC) in patients admitted to the ICU. Design: Pilot, prospective and comparative study. Setting: Eighteen ICUs (9 control and 9 intervention) from three autonomous communities in Spain during 3 months in 2007 participated in the study. Intervention: The following activities were included: a) training program for health care personnel, b) introduction of specific measures related to the insertion and care of CVC (catheter insertion checklist, basic recommendations for maintenance of central catheters, dedicated cart for venous accesses, information poster with the five procedures proposed to reduce bacteremias: hands hygiene, use of maximal aseptic barriers during insertion, asepsis of the skin at the insertion point with chlorhexidine, avoidance of the femoral access, and removal of all CVC) and c) measures aiming to promote the culture of safe daily work (daily objectives, learning from mistakes, safety rounds). Results: The rate of B-CVC expressed as mean values has shown a half reduction as compared with historical registers. Different problems in the implementation of specific measures related to catheters and safety tools were identified. Conclusions: The intervention project assessed in the pilot study may be viable on the national level. It is necessary to modify and adapt to the Spanish reality the interventions proposed (AU)

[Prevention of bacteriema related with ICU catheters by multifactorial intervention: a report of the pilot study]. / Prevención de la bacteriemia relacionada con catéteres en UCI mediante una intervención multifactorial. Informe del estudio piloto.

OBJECTIVE: to assess the applicability on a national level of the interventions proposed by Peter Pronovost et al in Michigan state for the prevention of central vascular catheter-related bacteremia (B-CVC) in patients admitted to the ICU. DESIGN: pilot, prospective and comparative study. SETTING: eighteen ICUs (9 control and 9 intervention) from three autonomous communities in Spain during 3 months in 2007 participated in the study. INTERVENTION: the following activities were included: a) training program for health care personnel, b) introduction of specific measures related to the insertion and care of CVC (catheter insertion checklist, basic recommendations for maintenance of central catheters, dedicated cart for venous accesses, information poster with the five procedures proposed to reduce bacteremias: hands hygiene, use of maximal aseptic barriers during insertion, asepsis of the skin at the insertion point with chlorhexidine, avoidance of the femoral access, and removal of all CVC) and c) measures aiming to promote the culture of safe daily work (daily objectives, learning from mistakes, safety rounds). RESULTS: the rate of B-CVC expressed as mean values has shown a half reduction as compared with historical registers. Different problems in the implementation of specific measures related to catheters and safety tools were identified. CONCLUSIONS: the intervention project assessed in the pilot study may be viable on the national level. It is necessary to modify and adapt to the Spanish reality the interventions proposed.