Preventing Central Venous Catheter-Associated Primary Bloodstream Infections

Characteristics of Practices among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) Study

Barbara I. Braun, Stephen B. Kritchevsky, Edward S. Wong, Steve L. Solomon, Lynn Steele, Cheryl L. Richards, Bryan P. Simmons, Diane Baranowsky, Sue Barnett, Sandi Baus, Jacqueline Berry, Terri Bethea, Gregory Bond, Barbara Bor, Diann Boyette, Jacqueline P. Butler, Ruth Carrico, Janine Chapman, Gwen Cunningham, Mary Dahlmann & 69 others Elizabeth DeHaan, Mario Javier DeLuca, Richard J. Duma, LeAnn Ellingson, Jeffrey Engel, Pam Falk, W. Lee Fanning, Christine Filippone, Brenda Grant, Bonnie Greene, Robert Grisnak, Peg Janasie, Carol Jarvis, Stuart Johnson, Najwa A. Khuri-Bulos, Joan Kies, Mary J K Kim, Brian Koll, Kenji Kono, Wesley Kozinn, Mary Kundus, Jane Lane, James W. Lederer, Francis J G Liu, Carlo Marena, Linda Matrician, Jean Maurice, Malkanthie I. McCormick, Clifford McDonald, Gerry McIlvenny, Kelley Melton, Ziad A. Memish, Juan Menares, Leonard Mermel, Paul M. Newell, Catherine O'Neill, Chik Hyun Pai, Steve Parenteau, Michael F. Parry, Cresio Romeu Pereira, Robert L. Pinsky, Didier Pittet, Jerome Robert, Debra A. Runyan, Barbara Russell, Ann Schlimm, Jacquelyn Seibert, G. Merrill Shore, Claudia Vallone Silva, Bryan Simmons, Marjeta Skerl, Edward T M Smyth, Alice Stankus, Connie Steed, Christopher J. Sullivan, Joseph R. Thurn, Martin Topiel, Antoni Trilla, Prity L. Vaidya, Bonnie Viergutz, Merceditas S. Villanueva, Carol Ward, Chatrchai Watanakunakorn, Stefan Weber, Sharon Welbel, Donna Winborne, Mary Wisniewski, Edward Wong, Kathryn Zink

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

OBJECTIVES: To describe the conceptual framework and methodology of the Evaluation of Processes and Indicators in Infection Control (EPIC) study and present results of CVC insertion characteristics and organizational practices for preventing BSIs. The goal of the EPIC study was to evaluate relationships among processes of care, organizational characteristics, and the outcome of BSI. DESIGN: This was a multicenter prospective observational study of variation in hospital practices related to preventing CVC-associated BSIs. Process of care information (eg, barrier use during insertions and experience of the inserting practitioner) was collected for a random sample of approximately 5 CVC insertions per month per hospital during November 1998 to December 1999. Organization demographic and practice information (eg, surveillance activities and staff and ICU nurse staffing levels) was also collected. SETTING: Medical, surgical, or medical-surgical ICUs from 55 hospitals (41 U.S. and 14 international sites). PARTICIPANTS: Process information was obtained for 3,320 CVC insertions with an average of 58.2 (± 16.1) insertions per hospital. Fifty-four hospitals provided policy and practice information. RESULTS: Staff spent an average of 13 hours per week in study ICU surveillance. Most patients received nontunneled, multiple lumen CVCs, of which fewer than 25% were coated with antimicrobial material. Regarding barriers, most clinicians wore masks (81.5%) and gowns (76.8%); 58.1% used large drapes. Few hospitals (18.1%) used an intravenous team to manage ICU CVCs. CONCLUSIONS: Substantial variation exists in CVC insertion practice and BSI prevention activities. Understanding which practices have the greatest impact on BSI rates can help hospitals better target improvement interventions.

Original languageEnglish
Pages (from-to)926-935
Number of pages10
JournalInfection Control and Hospital Epidemiology
Volume24
Issue number12
DOIs
Publication statusPublished - Dec 2003

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Central Venous Catheters
Infection Control
Infection
Masks
Observational Studies
Nurses
Demography
Organizations
Prospective Studies

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology

Cite this

Preventing Central Venous Catheter-Associated Primary Bloodstream Infections : Characteristics of Practices among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) Study. / Braun, Barbara I.; Kritchevsky, Stephen B.; Wong, Edward S.; Solomon, Steve L.; Steele, Lynn; Richards, Cheryl L.; Simmons, Bryan P.; Baranowsky, Diane; Barnett, Sue; Baus, Sandi; Berry, Jacqueline; Bethea, Terri; Bond, Gregory; Bor, Barbara; Boyette, Diann; Butler, Jacqueline P.; Carrico, Ruth; Chapman, Janine; Cunningham, Gwen; Dahlmann, Mary; DeHaan, Elizabeth; DeLuca, Mario Javier; Duma, Richard J.; Ellingson, LeAnn; Engel, Jeffrey; Falk, Pam; Fanning, W. Lee; Filippone, Christine; Grant, Brenda; Greene, Bonnie; Grisnak, Robert; Janasie, Peg; Jarvis, Carol; Johnson, Stuart; Khuri-Bulos, Najwa A.; Kies, Joan; Kim, Mary J K; Koll, Brian; Kono, Kenji; Kozinn, Wesley; Kundus, Mary; Lane, Jane; Lederer, James W.; Liu, Francis J G; Marena, Carlo; Matrician, Linda; Maurice, Jean; McCormick, Malkanthie I.; McDonald, Clifford; McIlvenny, Gerry; Melton, Kelley; Memish, Ziad A.; Menares, Juan; Mermel, Leonard; Newell, Paul M.; O'Neill, Catherine; Pai, Chik Hyun; Parenteau, Steve; Parry, Michael F.; Pereira, Cresio Romeu; Pinsky, Robert L.; Pittet, Didier; Robert, Jerome; Runyan, Debra A.; Russell, Barbara; Schlimm, Ann; Seibert, Jacquelyn; Shore, G. Merrill; Silva, Claudia Vallone; Simmons, Bryan; Skerl, Marjeta; Smyth, Edward T M; Stankus, Alice; Steed, Connie; Sullivan, Christopher J.; Thurn, Joseph R.; Topiel, Martin; Trilla, Antoni; Vaidya, Prity L.; Viergutz, Bonnie; Villanueva, Merceditas S.; Ward, Carol; Watanakunakorn, Chatrchai; Weber, Stefan; Welbel, Sharon; Winborne, Donna; Wisniewski, Mary; Wong, Edward; Zink, Kathryn.

In: Infection Control and Hospital Epidemiology, Vol. 24, No. 12, 12.2003, p. 926-935.

Research output: Contribution to journalArticle

Braun, BI, Kritchevsky, SB, Wong, ES, Solomon, SL, Steele, L, Richards, CL, Simmons, BP, Baranowsky, D, Barnett, S, Baus, S, Berry, J, Bethea, T, Bond, G, Bor, B, Boyette, D, Butler, JP, Carrico, R, Chapman, J, Cunningham, G, Dahlmann, M, DeHaan, E, DeLuca, MJ, Duma, RJ, Ellingson, L, Engel, J, Falk, P, Fanning, WL, Filippone, C, Grant, B, Greene, B, Grisnak, R, Janasie, P, Jarvis, C, Johnson, S, Khuri-Bulos, NA, Kies, J, Kim, MJK, Koll, B, Kono, K, Kozinn, W, Kundus, M, Lane, J, Lederer, JW, Liu, FJG, Marena, C, Matrician, L, Maurice, J, McCormick, MI, McDonald, C, McIlvenny, G, Melton, K, Memish, ZA, Menares, J, Mermel, L, Newell, PM, O'Neill, C, Pai, CH, Parenteau, S, Parry, MF, Pereira, CR, Pinsky, RL, Pittet, D, Robert, J, Runyan, DA, Russell, B, Schlimm, A, Seibert, J, Shore, GM, Silva, CV, Simmons, B, Skerl, M, Smyth, ETM, Stankus, A, Steed, C, Sullivan, CJ, Thurn, JR, Topiel, M, Trilla, A, Vaidya, PL, Viergutz, B, Villanueva, MS, Ward, C, Watanakunakorn, C, Weber, S, Welbel, S, Winborne, D, Wisniewski, M, Wong, E & Zink, K 2003, 'Preventing Central Venous Catheter-Associated Primary Bloodstream Infections: Characteristics of Practices among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) Study', Infection Control and Hospital Epidemiology, vol. 24, no. 12, pp. 926-935. https://doi.org/10.1086/502161
Braun, Barbara I. ; Kritchevsky, Stephen B. ; Wong, Edward S. ; Solomon, Steve L. ; Steele, Lynn ; Richards, Cheryl L. ; Simmons, Bryan P. ; Baranowsky, Diane ; Barnett, Sue ; Baus, Sandi ; Berry, Jacqueline ; Bethea, Terri ; Bond, Gregory ; Bor, Barbara ; Boyette, Diann ; Butler, Jacqueline P. ; Carrico, Ruth ; Chapman, Janine ; Cunningham, Gwen ; Dahlmann, Mary ; DeHaan, Elizabeth ; DeLuca, Mario Javier ; Duma, Richard J. ; Ellingson, LeAnn ; Engel, Jeffrey ; Falk, Pam ; Fanning, W. Lee ; Filippone, Christine ; Grant, Brenda ; Greene, Bonnie ; Grisnak, Robert ; Janasie, Peg ; Jarvis, Carol ; Johnson, Stuart ; Khuri-Bulos, Najwa A. ; Kies, Joan ; Kim, Mary J K ; Koll, Brian ; Kono, Kenji ; Kozinn, Wesley ; Kundus, Mary ; Lane, Jane ; Lederer, James W. ; Liu, Francis J G ; Marena, Carlo ; Matrician, Linda ; Maurice, Jean ; McCormick, Malkanthie I. ; McDonald, Clifford ; McIlvenny, Gerry ; Melton, Kelley ; Memish, Ziad A. ; Menares, Juan ; Mermel, Leonard ; Newell, Paul M. ; O'Neill, Catherine ; Pai, Chik Hyun ; Parenteau, Steve ; Parry, Michael F. ; Pereira, Cresio Romeu ; Pinsky, Robert L. ; Pittet, Didier ; Robert, Jerome ; Runyan, Debra A. ; Russell, Barbara ; Schlimm, Ann ; Seibert, Jacquelyn ; Shore, G. Merrill ; Silva, Claudia Vallone ; Simmons, Bryan ; Skerl, Marjeta ; Smyth, Edward T M ; Stankus, Alice ; Steed, Connie ; Sullivan, Christopher J. ; Thurn, Joseph R. ; Topiel, Martin ; Trilla, Antoni ; Vaidya, Prity L. ; Viergutz, Bonnie ; Villanueva, Merceditas S. ; Ward, Carol ; Watanakunakorn, Chatrchai ; Weber, Stefan ; Welbel, Sharon ; Winborne, Donna ; Wisniewski, Mary ; Wong, Edward ; Zink, Kathryn. / Preventing Central Venous Catheter-Associated Primary Bloodstream Infections : Characteristics of Practices among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) Study. In: Infection Control and Hospital Epidemiology. 2003 ; Vol. 24, No. 12. pp. 926-935.
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abstract = "OBJECTIVES: To describe the conceptual framework and methodology of the Evaluation of Processes and Indicators in Infection Control (EPIC) study and present results of CVC insertion characteristics and organizational practices for preventing BSIs. The goal of the EPIC study was to evaluate relationships among processes of care, organizational characteristics, and the outcome of BSI. DESIGN: This was a multicenter prospective observational study of variation in hospital practices related to preventing CVC-associated BSIs. Process of care information (eg, barrier use during insertions and experience of the inserting practitioner) was collected for a random sample of approximately 5 CVC insertions per month per hospital during November 1998 to December 1999. Organization demographic and practice information (eg, surveillance activities and staff and ICU nurse staffing levels) was also collected. SETTING: Medical, surgical, or medical-surgical ICUs from 55 hospitals (41 U.S. and 14 international sites). PARTICIPANTS: Process information was obtained for 3,320 CVC insertions with an average of 58.2 (± 16.1) insertions per hospital. Fifty-four hospitals provided policy and practice information. RESULTS: Staff spent an average of 13 hours per week in study ICU surveillance. Most patients received nontunneled, multiple lumen CVCs, of which fewer than 25{\%} were coated with antimicrobial material. Regarding barriers, most clinicians wore masks (81.5{\%}) and gowns (76.8{\%}); 58.1{\%} used large drapes. Few hospitals (18.1{\%}) used an intravenous team to manage ICU CVCs. CONCLUSIONS: Substantial variation exists in CVC insertion practice and BSI prevention activities. Understanding which practices have the greatest impact on BSI rates can help hospitals better target improvement interventions.",
author = "Braun, {Barbara I.} and Kritchevsky, {Stephen B.} and Wong, {Edward S.} and Solomon, {Steve L.} and Lynn Steele and Richards, {Cheryl L.} and Simmons, {Bryan P.} and Diane Baranowsky and Sue Barnett and Sandi Baus and Jacqueline Berry and Terri Bethea and Gregory Bond and Barbara Bor and Diann Boyette and Butler, {Jacqueline P.} and Ruth Carrico and Janine Chapman and Gwen Cunningham and Mary Dahlmann and Elizabeth DeHaan and DeLuca, {Mario Javier} and Duma, {Richard J.} and LeAnn Ellingson and Jeffrey Engel and Pam Falk and Fanning, {W. Lee} and Christine Filippone and Brenda Grant and Bonnie Greene and Robert Grisnak and Peg Janasie and Carol Jarvis and Stuart Johnson and Khuri-Bulos, {Najwa A.} and Joan Kies and Kim, {Mary J K} and Brian Koll and Kenji Kono and Wesley Kozinn and Mary Kundus and Jane Lane and Lederer, {James W.} and Liu, {Francis J G} and Carlo Marena and Linda Matrician and Jean Maurice and McCormick, {Malkanthie I.} and Clifford McDonald and Gerry McIlvenny and Kelley Melton and Memish, {Ziad A.} and Juan Menares and Leonard Mermel and Newell, {Paul M.} and Catherine O'Neill and Pai, {Chik Hyun} and Steve Parenteau and Parry, {Michael F.} and Pereira, {Cresio Romeu} and Pinsky, {Robert L.} and Didier Pittet and Jerome Robert and Runyan, {Debra A.} and Barbara Russell and Ann Schlimm and Jacquelyn Seibert and Shore, {G. Merrill} and Silva, {Claudia Vallone} and Bryan Simmons and Marjeta Skerl and Smyth, {Edward T M} and Alice Stankus and Connie Steed and Sullivan, {Christopher J.} and Thurn, {Joseph R.} and Martin Topiel and Antoni Trilla and Vaidya, {Prity L.} and Bonnie Viergutz and Villanueva, {Merceditas S.} and Carol Ward and Chatrchai Watanakunakorn and Stefan Weber and Sharon Welbel and Donna Winborne and Mary Wisniewski and Edward Wong and Kathryn Zink",
year = "2003",
month = "12",
doi = "10.1086/502161",
language = "English",
volume = "24",
pages = "926--935",
journal = "Infection Control and Hospital Epidemiology",
issn = "0899-823X",
publisher = "University of Chicago Press",
number = "12",

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TY - JOUR

T1 - Preventing Central Venous Catheter-Associated Primary Bloodstream Infections

T2 - Characteristics of Practices among Hospitals Participating in the Evaluation of Processes and Indicators in Infection Control (EPIC) Study

AU - Braun, Barbara I.

AU - Kritchevsky, Stephen B.

AU - Wong, Edward S.

AU - Solomon, Steve L.

AU - Steele, Lynn

AU - Richards, Cheryl L.

AU - Simmons, Bryan P.

AU - Baranowsky, Diane

AU - Barnett, Sue

AU - Baus, Sandi

AU - Berry, Jacqueline

AU - Bethea, Terri

AU - Bond, Gregory

AU - Bor, Barbara

AU - Boyette, Diann

AU - Butler, Jacqueline P.

AU - Carrico, Ruth

AU - Chapman, Janine

AU - Cunningham, Gwen

AU - Dahlmann, Mary

AU - DeHaan, Elizabeth

AU - DeLuca, Mario Javier

AU - Duma, Richard J.

AU - Ellingson, LeAnn

AU - Engel, Jeffrey

AU - Falk, Pam

AU - Fanning, W. Lee

AU - Filippone, Christine

AU - Grant, Brenda

AU - Greene, Bonnie

AU - Grisnak, Robert

AU - Janasie, Peg

AU - Jarvis, Carol

AU - Johnson, Stuart

AU - Khuri-Bulos, Najwa A.

AU - Kies, Joan

AU - Kim, Mary J K

AU - Koll, Brian

AU - Kono, Kenji

AU - Kozinn, Wesley

AU - Kundus, Mary

AU - Lane, Jane

AU - Lederer, James W.

AU - Liu, Francis J G

AU - Marena, Carlo

AU - Matrician, Linda

AU - Maurice, Jean

AU - McCormick, Malkanthie I.

AU - McDonald, Clifford

AU - McIlvenny, Gerry

AU - Melton, Kelley

AU - Memish, Ziad A.

AU - Menares, Juan

AU - Mermel, Leonard

AU - Newell, Paul M.

AU - O'Neill, Catherine

AU - Pai, Chik Hyun

AU - Parenteau, Steve

AU - Parry, Michael F.

AU - Pereira, Cresio Romeu

AU - Pinsky, Robert L.

AU - Pittet, Didier

AU - Robert, Jerome

AU - Runyan, Debra A.

AU - Russell, Barbara

AU - Schlimm, Ann

AU - Seibert, Jacquelyn

AU - Shore, G. Merrill

AU - Silva, Claudia Vallone

AU - Simmons, Bryan

AU - Skerl, Marjeta

AU - Smyth, Edward T M

AU - Stankus, Alice

AU - Steed, Connie

AU - Sullivan, Christopher J.

AU - Thurn, Joseph R.

AU - Topiel, Martin

AU - Trilla, Antoni

AU - Vaidya, Prity L.

AU - Viergutz, Bonnie

AU - Villanueva, Merceditas S.

AU - Ward, Carol

AU - Watanakunakorn, Chatrchai

AU - Weber, Stefan

AU - Welbel, Sharon

AU - Winborne, Donna

AU - Wisniewski, Mary

AU - Wong, Edward

AU - Zink, Kathryn

PY - 2003/12

Y1 - 2003/12

N2 - OBJECTIVES: To describe the conceptual framework and methodology of the Evaluation of Processes and Indicators in Infection Control (EPIC) study and present results of CVC insertion characteristics and organizational practices for preventing BSIs. The goal of the EPIC study was to evaluate relationships among processes of care, organizational characteristics, and the outcome of BSI. DESIGN: This was a multicenter prospective observational study of variation in hospital practices related to preventing CVC-associated BSIs. Process of care information (eg, barrier use during insertions and experience of the inserting practitioner) was collected for a random sample of approximately 5 CVC insertions per month per hospital during November 1998 to December 1999. Organization demographic and practice information (eg, surveillance activities and staff and ICU nurse staffing levels) was also collected. SETTING: Medical, surgical, or medical-surgical ICUs from 55 hospitals (41 U.S. and 14 international sites). PARTICIPANTS: Process information was obtained for 3,320 CVC insertions with an average of 58.2 (± 16.1) insertions per hospital. Fifty-four hospitals provided policy and practice information. RESULTS: Staff spent an average of 13 hours per week in study ICU surveillance. Most patients received nontunneled, multiple lumen CVCs, of which fewer than 25% were coated with antimicrobial material. Regarding barriers, most clinicians wore masks (81.5%) and gowns (76.8%); 58.1% used large drapes. Few hospitals (18.1%) used an intravenous team to manage ICU CVCs. CONCLUSIONS: Substantial variation exists in CVC insertion practice and BSI prevention activities. Understanding which practices have the greatest impact on BSI rates can help hospitals better target improvement interventions.

AB - OBJECTIVES: To describe the conceptual framework and methodology of the Evaluation of Processes and Indicators in Infection Control (EPIC) study and present results of CVC insertion characteristics and organizational practices for preventing BSIs. The goal of the EPIC study was to evaluate relationships among processes of care, organizational characteristics, and the outcome of BSI. DESIGN: This was a multicenter prospective observational study of variation in hospital practices related to preventing CVC-associated BSIs. Process of care information (eg, barrier use during insertions and experience of the inserting practitioner) was collected for a random sample of approximately 5 CVC insertions per month per hospital during November 1998 to December 1999. Organization demographic and practice information (eg, surveillance activities and staff and ICU nurse staffing levels) was also collected. SETTING: Medical, surgical, or medical-surgical ICUs from 55 hospitals (41 U.S. and 14 international sites). PARTICIPANTS: Process information was obtained for 3,320 CVC insertions with an average of 58.2 (± 16.1) insertions per hospital. Fifty-four hospitals provided policy and practice information. RESULTS: Staff spent an average of 13 hours per week in study ICU surveillance. Most patients received nontunneled, multiple lumen CVCs, of which fewer than 25% were coated with antimicrobial material. Regarding barriers, most clinicians wore masks (81.5%) and gowns (76.8%); 58.1% used large drapes. Few hospitals (18.1%) used an intravenous team to manage ICU CVCs. CONCLUSIONS: Substantial variation exists in CVC insertion practice and BSI prevention activities. Understanding which practices have the greatest impact on BSI rates can help hospitals better target improvement interventions.

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DO - 10.1086/502161

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VL - 24

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EP - 935

JO - Infection Control and Hospital Epidemiology

JF - Infection Control and Hospital Epidemiology

SN - 0899-823X

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