ARTICLE IN PRESS International Journal of Nursing Studies 44 (2007) 1324–1333 The effectiveness of a nurse-initiated intervention to reduce catheter-associated bloodstream infections in an urban acute hospital: An intervention study with before and after comparison Toshie Tsuchida a,Ã,1 , Kiyoko Makimoto a , Masayo Toki b , Keiko Sakai b , Emiko Onaka b , Yoshiko Otani b a Department of Nursing, Graduate School of Nursing, Osaka University, 1–7 Yamadaoka, Suita city, Osaka 565-0871, Japan b Osaka Koseinenkin Hospital, Osaka, Japan Received 7 February 2006; received in revised form 12 July 2006; accepted 13 July 2006 Abstract Background: Catheter care is considered to be important for prevention of catheter-associated bloodstream infections (CABSIs) although epidemiological evidence is sparse. Objectives: To identify problems associated with catheter care and evaluate the effectiveness of nurse-initiated interventions to reduce CABSIs. Design: An intervention study with before and after comparison. Settings: CABSI surveillance was conducted in a 560-bed acute hospital located in a major urban area in Japan. Participants: Patients were enrolled in this study from April 2000 to December 2002 based on the following criteria: (1) adult inpatients; and (2) those in whom central venous lines or Swan-Ganz catheters were inserted for 2 days or longer. Methods: In the first year, risk factors for CABSI and problems associated with catheter care were identified by inspection of the infection control nurse (ICN) or four trained link nurses, and the laboratory results. In the subsequent 2 years, the following interventions based on the surveillance results were implemented: (1) enhanced skin preparation by scrubbing with regular bathing soap and tap water; (2) a new method for stabilisation of the catheter inserted into the internal jugular vein, where additional dressing was placed over the sterilised dressing; (3) educating the staff on maximal sterile precautions by teaching staff members at their section meetings and displaying posters; (4) use of a check list and observation of catheter insertion by link nurses to monitor compliance; and (5) selection of a disinfectant that requires shorter contact time and has longer residual effect. Results: After these interventions were implemented, the overall bloodstream infection (BSI) rate declined from 4.0/ 1000 device-days to 1.1/1000 device-days (po0.005). Conclusions: We identified four problems—those related to skin preparation, dressing, sterile precautions and disinfectant. We implemented a series of interventions to reduce CABSIs; the overall CABSI rate decreased significantly. r 2006 Elsevier Ltd. All rights reserved. Keywords: Bloodstream infections; Catheter care; Nursing interventions www.elsevier.com/locate/ijnurstu 0020-7489/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.ijnurstu.2006.07.008 Ã Corresponding author. Tel./fax: 81 6 6879 2541. E-mail address: tosie@a2.mbn.or.jp (T. Tsuchida). 1 Home address: 1-10-35-213 Uenosaka Toyonaka Osaka, 560-0012, Japan.