• L Silvia Munoz-Price, Cameron Dezfulian, Mary Wyckoff, Joshua D Lenchus, Mara Rosalsky, David J Birnbach, and Kristopher L Arheart.
• Department of Medicine, Division of Biostatistics, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA. smunozprice@med.miami.edu
• Crit. Care Med.. 2012 May 1;40(5):1464-9.

ObjectiveDetermine the impact of three stepwise interventions on the rate of central catheter-associated bloodstream infections.DesignQuasi-experimental study.SettingThree surgical intensive care units (general surgery, trauma, and neurosurgery) at a 1500-bed county teaching hospital in the Miami metro area.PatientsAll consecutive central catheter-associated bloodstream infection cases as determined by the Infection Control Department.InterventionsThree interventions aimed at catheter maintenance were implemented at different times in the units: chlorhexidine "scrub-the-hub," chlorhexidine daily baths, and daily nursing rounds aimed at assuring compliance with an intensive care unit goal-oriented checklist.Measurements And Main ResultsThe primary outcome was the monthly intensive care unit rate of central catheter-associated bloodstream infections (infections per 1000 central catheter days). Over 33 months of follow-up (July 2008 to March 2011), we found decreased rates in each of the three intensive care units evaluated during the interventions, especially after implementation of chlorhexidine daily baths. Rates in unit A decreased from a rate of 8.6 to 0.5, unit B from 6.9 to 1.6, and unit C from 7.8 to 0.6. Secondary bloodstream infection rates remained unchanged throughout the observation period in units A and B; however, unit C had a decrease in its rates over time.ConclusionsWe report the progressive reduction of central catheter-associated bloodstream infection rates after the stepwise implementation of chlorhexidine "scrub-the-hub" and daily baths in surgical intensive care units, suggesting effectiveness of these interventions.

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