The low to very low quality of the evidence of studies included in this review provides insufficient evidence to determine with certainty which interventions are most effective in changing professional behaviour and in what contexts. However, interventions that may be worth further study are educational interventions involving more than one active element and that are repeatedly administered over time, and interventions employing specialised personnel, who are focused on an aspect of care that is supported by evidence e.g. dentists/dental auxiliaries performing oral care for VAP prevention.
Catheter management protocol for catheter-related bacteremia prophylaxis.
This study reports a prospective observational study in which an infection prophylaxis protocol based on the National Kidney Foundation's Kidney Disease Outcomes and Quality Initiative (NKF-K/DOQI) guideline 15 describing guidelines for the care of the tunneled dialysis catheter at the time of catheter hook-up for dialysis was used. Catheter-related bacteremia (CRB) incidence data were collected for a 24-month study period and compared to retrospectively collected control data for the immediately preceding 9 months in the same patient population under the same conditions except for the prophylaxis protocol. The incidence of CRB fell from an average level of 6.97 per 1,000 catheter-days during the control period to an average of 1.68 during the study period. This change was statistically significant. Although the lowered incidence required 6 months to reach its maximum, the decreased infection rate was sustained. The average incidence during the last 18 months of the study period was 1.28 per 1,000 catheter-days. Staff compliance with the protocol did require repetitive education and assessment.