Catheter‐related blood stream infection (CRBSI) in TPN patients: Benefit of an educational programme and multimodal expression of CRBSI incidence

Catheter related blood stream infection (CRBSI) remains an important complication of central venous catheters(CVCs). Educational programmes have been associated with CRBSI reduction but evidence in total parenteral nutrition (TPN) patients is limited, despite an increased risk of CRBSI. The effect of educational processes were evaluated and the value of different methods of expression of CRBSI incidence were assessed.

Study was performed in a 525‐bed tertiary university hospital over 12 years. A multidisciplinary TPN committee was created to examine CRBSI episodes and a parallel education programme was set up and maintained. Prospectively collected data were analysed from 1,392 patients in whom 2,565 CVCs were used over 15,397 CVC days. CRBSI incidence was expressed as CRBSI episodes per 1,000 CVC days, percentage patients or percentage CVCs infected.

CRBSI incidence fell from 33 to 7 episodes per 1,000 CVC days (p<0.01). Percentage of infected CVCs fell from 17 per cent to 5 per cent(p <0.05) and proportion of patients affected fell from 27 per cent to 7 per cent(p <0.01). The corresponding slopes of the lines expressing fall in CRBSI rate were −1.3‐0.63 and −1.4 respectively.

A sustained educational programme was associated with a significant fall in CRBSI in TPN patients. An incidence of 5‐7 episodes per 1,000 CVC days, a figure comparable with non‐TPN CVCs, was achievable.

Each method of expression of CRBSI incidence proved valid in this setting and contributed to the educational programme.

The value of this study is that it demonstrates how implementing and sustaining an education programme can achieve reduced rates of infection. No published study utilising all methods of expressing CRBSI incidence could be found.