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RESULTS: Between September 2002 and November 2003, 1164 ICU patients with CVCs were enrolled. Patients
during each study phase were similar with respect to gender, underlying disease, severity-of-illness score, and
central venous catheter longevity. Compliance with CVC care was similar during the two study phases.
Handwashing compliance was above 75%, and the presence of an occlusive sterile catheter dressing was above
98% during both phases of the study. There was a total of 4584 CVC days during phase one and 3995 CVC days
during phase two. The rate of CVC-associated BSI (laboratory-conrmed bloodstream infection, or LCBI, and
clinical sepsis, or CSEP) during phase one was higher than during phase two (16.97 versus 3.00 BSIs per 1000 CVCdays, RR = 0.18, 95% CI = 0.10-0.32, p=0.0000).
In a previous study we quantied the attributable extra costs of CVC-associated BSI in the same ICUs. CVCassociated BSIs extended ICU average length of stay by 6.05 days and resulted in added ICU costs of $6899 per
patient. With a baseline CVC-associated BSI rate of 16.97 per 1000 CVC-days, 67 BSIs would have been expected to
occur during the 3995 line-days over 21 ICU-months of phase two. During this time using the closed system, we
documented 12 BSIs instead of 67, a reduction of 55 BSIs. This resulted in a reduction of 332.75 ICU days and a
calculated cost savings during the 21 ICU-month intervention period of $379,445. This corresponds to 15.84 days
and $18,069 saved per ICU per month, or a saving of 190 days and $216,826 per ICU per year.
CONCLUSION: Adoption of a closed infusion system in four ICUs of three Mexican hospitals resulted in signicant
reduction in BSI rates and costs, with a savings of 190 ICU days and $216,826 per ICU per year.

Device-Related Infections
Abstract ID 50571
Monday, June 20

Reduction in catheter-associated urinary tract infections (CAUTIs) using


a silver-coated 100% silicone Foley catheter verses a silver-coated latex
Foley catheter in a Northeastern U.S. acute care hospital
K Davis
Arnot Ogden Medical Center, Elmira, New York
BACKGROUND/OBJECTIVES: Aside from decreasing urethritis, encrustations, and strictures with the use of 100%
silicone catheters, little is documented about the impact that silver-coated 100% silicone Foley catheters have on
patient safety and the prevention of catheter-associated urinary tract infections (CAUTIs). In this 256-bed acute care
hospital located in Elmira, New York, routine surveillance is ongoing to isolate CAUTIs and to identify interventions
to decrease infection rates. To evaluate the effectiveness of a silver-coated silicone Foley catheter, a decision was
made to compare the hospitals existing CAUTI rate using a silver-coated latex Foley catheter to the current CAUTI
rate using a silver-coated 100% silicone catheter.
METHODS: Using CDC denitions, a 6-month concurrent housewide CAUTI surveillance study was performed. A
comprehensive chart review was conducted for all adult inpatients with Foley catheters who presented with
positive urine cultures at least 48 hours after admission. Patients transferred from other facilities with a preexisting Foley catheter were excluded. The baseline period employing silver-coated latex Foley catheters was
January through June 2003. These months were then compared to the same months, utilizing the silver-coated
100% silicone Foley catheter, in 2004.
RESULTS: The hospitals decision to convert from a silver-coated latex Foley catheter to a silver-coated 100%
silicone Foley catheter resulted in a 69% reduction in CAUTIs (p=0.014). Using the silver-coated latex Foley
catheter, the average CAUTI rate in 2003 was 3 infections per 1000 Foley catheter days. In 2004, using the silvercoated 100% silicone Foley catheter, the average CAUTI rate was 0.93 infections per 1000 Foley catheter days.
CONCLUSIONS: Silver-coated 100% silicone Foley catheters can reduce the incidence of CAUTI in an acute care
hospital compared to silver-coated latex catheters. These catheters can also eliminate the additional complications

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associated with latex. Based on these patient and provider safety benets, silver-coated 100% silicone Foley
catheters are the standard of care at this medical center.

Abstract ID 50644
Monday, June 20

Reduction of the catheter-associated bloodstream infection rate and an


opportunity to improve the quality of care in a long-term acute care
hospital
R Christman
J Naktin
P Miles
G Wuchter
E Anderson
Good Shepherd Specialty Hospital, Allentown, Pennsylvania
BACKGROUND/OBJECTIVES: A 29-bed long-term acute care hospital (LTCH) that cares for critically ill, but
medically stable patients requiring hospitalization for 25 days or more is located in a large tertiary-care hospital.
The patient population at LTCH is dominated by those requiring mechanical ventilation and those with debilitating
illness requiring a central line for intravenous therapy. Peripherally inserted central catheters (PICC) are the
preferred type of intravenous access. For as many as 40%-70% of our patients, their condition is compromised by a
previously occurring infection. It is not uncommon for such debilitated patients to carry a combination of two or
more resistant organisms necessitating isolation. Most patients arrive with previously inserted central lines.
Nearly 75% of the patients arrive with a PICC in place. The other 25% have a PICC inserted near the time of
admission. The PICC team is a contracted resource to LTCH. We do not have any control over the insertion
procedure, the brand of central lines, the products used for prepping, or the initial dressing used for insertion site.
These limitations truly restricted our options and forced us to use our most creative and analytic resources to
determine an effective strategy to decrease our bloodstream infection (BSI) rate. After researching the products
available on the market for our use, we decided to use a dressing at the insertion site that was impregnated with
chlorohexidine gluconate (CHG).
METHODS: The Centers for Disease Control and Prevention (CDC) denitions for primary center venous catheter
(CVC)-healthcare-associated infections (HAIs) were used. During April 2003, the staff participated in a mandatory
inservice on aseptic dressing technique and proper placement of the CHG dressing within 24 hours of admission.
RESULTS: The BSI rate for January-December 2002 was 4.4/1000 CVC days. The BSI rate for January-December
2003 was 1.21/1000 CVC days, a decrease of 72.5% from previous year. The BSI rate for January-September 2004
was 1.05/100 CVC days, a decrease of 76% since project start and a 16% decrease from the previous year.
CONCLUSIONS: The implementation of CHG-impregnated dressing on the PICC site within 24 hours of admission
along with the educational interventions on aseptic technique and policy changes successfully lowered the
CVC-associated BSI rate in LTCH.

Abstract ID 51455
Tuesday, June 21

Increasing isolation room surge capacity through the establishment of


negative-pressure surge capacity wings/areas
D Tomczyk
Wisconsin Division of Public Health, Madison, Wisconsin