Eliminating catheter-related bloodstream infections in the intensive care unit

Sean M. Berenholtz, Peter J Pronovost, Pamela A. Lipsett, Deborah Hobson, Karen Earsing, Jason E. Parley, Shelley Milanovich, Elizabeth Garrett-Mayer, Bradford D. Winters, Haya R. Rubin, Todd Dorman, Trish M Perl

Research output: Contribution to journalArticlepeer-review

696 Scopus citations


Objective: To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (PR-BSIs). Design: Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control IGU. Setting: The Johns Hopkins Hospital. Patients: All patients with a central venous catheter in the ICU. Intervention: To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed. Measurement: The primary outcome variable was the rate of CH-BSIs per 1,000 catheter days from January 1,1938, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion. Main Results: Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study IGU decreased from 11.3/1,000 catheter days in the first quarter of 1938 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and $1,945,322 in additional costs per year in the study ICU. Conclusions: Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.

Original languageEnglish (US)
Pages (from-to)2014-2020
Number of pages7
JournalCritical care medicine
Issue number10
StatePublished - Oct 2004


  • Catheterization, central venous
  • Infection, nosocomial
  • Intensive care units
  • Organisational innovation
  • Total quality management

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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