An estimated 80,000 infections a year are related to central lines in ICUs. Such infections are certainly expensive and can be deadly. Despite "best practice" infection control measures such as line insertion checklists, staff education, and unit-level "champions," central line-associated bloodstream infections continue to plague hospitalized patients.

A group of researchers from a U.S. hospital evaluated the effect of adding a unit-based "quality nurse" to oversee infection control activities with a focus on central line infections in their surgical ICU (SICU). The nurse dedicated to the role first received specialized infection control training. The quality nurse's responsibilities included educating staff, observing central line insertions and dressing changes to monitor compliance and deliver individual feedback, performing daily central line assessments and rounds with the medical team, and holding weekly safety meetings to discuss strategies that might have prevented those infections that did occur on the unit.

In the two years before the intervention (July 2008 through June 2010), the average monthly rate of central line-associated bloodstream infections in the SICU was five per 1,000 central line-days and the central line use ratio was 0.82 (10,622 central line-days during 13,086 patient-days). In the postintervention period (July 2010 through March 2012), the average monthly rate of central line infections decreased to 1.5 per 1,000 central line-days (a 70% decrease), and the central line use ratio dropped to 0.66 (7,571 central line-days during 11,490 patient-days).

The researchers adjusted for confounding factors such as illness severity, study month, involvement in other unit-based infection control initiatives, and infection rates in all other adult ICUs (there was an overall decline in central line infections across all ICUs during the study time period). Despite the overall decline in central line-associated bloodstream infections, there was considerable fluctuation in the rate during the intervention period, which corresponded substantially to how much time the quality nurse spent on the unit.

The substantial reduction in infections per central line-days during the intervention period equated to roughly 11.4 central line infections that could be prevented in a year, which translates into an estimated cost savings of $205,200. The results of this study, though confined to one ICU, suggest that a quality nurse may be an effective weapon in the battle against central line infections.-AK

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