A focused intervention primarily directed at the ICU nursing staff can lead to a dramatic decrease in the incidence of primary bloodstream infections. Educational programs may lead to a substantial decrease in cost, morbidity, and mortality attributable to central venous catheterization.

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The success of an educational program in July 1999 that lowered the catheter-related bloodstream infection (CRBSI) rate in our intensive care unit (ICU) 3-fold is correlated with compliance with "bestpractice" behaviors.Design: Before-after trial.Setting: Surgical ICU in a referral hospital.Patients: A random sample underwent bedside audits of central venous catheter care (n = 187). All ICU admissions during a 39-month period (N = 4489) were prospectively followed for bacteremia.Interventions: On the basis of audit results in December 2000, a behavioral intervention was designed to improve compliance with evidenced-based guidelines of central venous catheter management. Main Outcome Measures: Compliance with practices known to decrease CRBSI. Secondary outcome was CRBSI rate on all ICU patients. Results: Multiple deficiencies were identified on bed-

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