{"paper_id":"3d4ac108-7bf9-4110-baec-daafc2f7bb87","body_text":"Successful multimodal intervention to prevent catheter-related bacteremia in conventional wards (PREVCATH) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Successful multimodal intervention to prevent catheter-related bacteremia in conventional wards (PREVCATH) Oriol Gasch, Montserrat Ortega-Raya, Maria López-Sánchez, Marta Andrés, and 23 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8553085/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: Catheter-related bacteraemia (CRBs) are a major cause of healthcare-associated morbidity and mortality. Although preventive measures have reduced CRB incidence in intensive care units (ICUs), their impact in conventional hospital wards remains limited. This study evaluated a multimodal intervention programme to prevent CRB in non-ICU settings. Methods: We conducted a prospective, multicentre interventional study across eight Spanish hospitals. Three periods were defined: (i) Pre-intervention (12 months), during which standard practices were maintained; (ii) Intervention (6 months), comprising staff training and implementation of insertion and maintenance bundles; and (iii) Post-intervention (12 months), during which outcomes were monitored. The incidence rate ratio (IRR) for CRB was analysed using Poisson regression models, with the total number of hospital stays as the offset. Results: During the intervention, 7,737 vascular catheters were placed (mean dwell time: 3.0 days) in 4,557 patients across medical (72%) and surgical (28%) wards. Devices used were mainly short peripheral catheters (90.1%), followed by midlines (6.6%), peripherally inserted central catheters (3.2%), and central lines (0.2%), primarily for medication administration (98%). CRB incidence dropped from 0.22 per 1,000 hospital stays pre-intervention to 0.16 during intervention and 0.13 post-intervention. Poisson regression showed a significant CRB reduction after the intervention (IRR 0.59; 95% CI: 0.35–0.98). Conclusions: The implementation of a multimodal preventive programme in conventional hospitalisation wards was associated with a significant and sustained reduction in CRB incidence over a 12-month follow-up period. These findings highlight the importance and feasibility of extending preventive strategies beyond the ICU setting. Catheter-related bacteremia catheter failure multimodal preventive intervention Figures Figure 1 Figure 2 Background The utilization of vascular devices is integral to the management of hospitalized patients, frequently facilitating the administration of intravenous therapies, fluids, parenteral nutrition, and hemodialysis. Vascular catheters, notably peripheral and central vascular catheters (PVCs and CVCs), represent the most commonly employed devices in clinical practice, with reported prevalence rates of 50–70% and approximately 10%, respectively, among hospitalized patients (1,2). Catheter failure remains a frequent and clinically significant issue, with failure rates ranging from 30% to 50% for PVCs and approximately 3% for CVCs. Failures may be mechanical (e.g., occlusion, dislodgement), infectious (e.g., catheter-related bacteremia [CRBs]), or thrombotic (e.g., catheter-related thrombosis). Such complications are associated with prolonged hospitalization, increased healthcare costs, and elevated risks of morbidity and mortality, thereby underscoring the urgent need for enhanced preventive strategies and management protocols (3). Among hospital-acquired infections, those associated with vascular catheters rank among the most prevalent, alongside surgical site infections, urinary tract infections, and hospital-acquired pneumonia. CRB represents the most severe catheter-associated complication, carrying an estimated mortality rate of approximately 25% when it is originated in a central-line (4). In addition, CRB significantly prolongs hospital stays and imposes substantial financial burdens, with each case of CVC-related bacteremia estimated to cost around €31,381 (5). CRBs account for approximately 25% of all nosocomial bacteremia s (6). Although incidence rates are higher within intensive care units (ICUs), the absolute number of CRB episodes is greater in conventional hospital wards. The incidence of CRB ranges from 0.5 episodes per 1,000 patient-days for PVCs to 2.7 episodes per 1,000 patient-days for CVCs (7). Over the past two decades, the implementation of preventive bundles in ICUs—encompassing hand hygiene, chlorhexidine-based skin antisepsis, maximal barrier precautions during catheter insertion, daily evaluation of catheter necessity, and the avoidance of femoral access—has significantly reduced CRB incidence (8). The Spanish Bacteremia Zero initiative exemplifies such success (9). Nevertheless, similar reductions have not been achieved in conventional hospital wards, particularly concerning PVC- and PICC-related infections (10). In Catalonia, the VINCat program, initiated in 2006, aimed to reduce healthcare-associated infection rates through continuous active surveillance and the application of preventive interventions. CRB surveillance remains a central component of VINCat (6). Over the past decade, 8,049 CRB episodes meeting VINCat criteria were recorded, with an overall incidence declining from 0.28 to 0.21 episodes per 1,000 hospital stays between 2008 and 2018. This reduction was largely attributable to decreased CVC-related bacteremia s, whereas episodes linked to PVCs and PICCs have increased. Notably, this decline was observed exclusively within ICU settings, with no significant improvement detected in conventional hospital wards (11). The primary objective of this study was to assess the impact of a multimodal preventive program on catheter failure rates and CRB incidence within conventional hospitalization wards across several Spanish hospitals. Secondary objectives included the evaluation of long-term adherence to the preventive measures and their sustained clinical impact. Methods Study Design This prospective, multicenter interventional study was conducted across eight public healthcare system hospitals in Catalonia: Hospital de Bellvitge, Hospital de Terrassa, Hospital Parc Taulí de Sabadell, Hospital de Sant Pau, Hospital Josep Trueta de Girona, Hospital Germans Trias i Pujol, Hospital de Barcelona, and Hospital Mútua de Terrassa. Collectively, these centers account for approximately 950,000 hospital stays annually. Further details on the characteristics of the participating hospitals are provided in Supplementary Table 1. At each participating hospital, the principal investigator (PI) was a member of the VINCat Group for Bloodstream and Vascular Catheter-Related Infections and formed part of the Infection Control Team. The Infection Control Team was responsible for ensuring methodological adherence and routinely monitored all CRB episodes identified via microbiology laboratory reporting. Study Population In each hospital, one to three conventional medical and surgical hospitalization units were selected for inclusion. All catheters inserted in patients admitted to these units were managed according to the study protocol. The study comprised three periods: Pre-intervention period (12 months): Usual preventive practices established at each center continued within the selected units. CRB episodes were recorded throughout this period. In addition, historical CRB incidence data (2009–2021) were collected to estimate the expected incidence during the intervention. Intervention period (6 months): The intervention phase was implemented during 2022 and lasted six months in each participating hospital. Each center initiated the intervention as soon as the necessary approvals and local infrastructure were in place. Most hospitals launched the intervention between January and February 2022, while one hospital began in May 2022. Healthcare professionals (physicians and nurses) in the participating units received initial training. Following catheter insertion, a checklist was completed to assess adherence to the insertion and maintenance bundles (Supplementary Figure 1), which included: (i) appropriate catheter type and insertion site selection; (ii) hand hygiene using alcohol-based hand rub; (iii) skin antisepsis with 2% chlorhexidine in alcohol; (iv) use of appropriate insertion materials; (v) daily inspection of the dressing and insertion site, with immediate removal of catheters no longer required or associated with complications. Relevant patient and catheter information was documented daily by the project investigators at each center using a structured electronic verification form. Adherence to infection prevention and control measures was monitored through checklists and daily catheter inspections. At the time of insertion, the attending nurse completed a standardized insertion checklist, documenting key aseptic practices such as hand hygiene, use of personal protective equipment, skin antisepsis, and dressing technique. These were not direct observations by project staff. In addition, members of the project team performed daily inspections of all catheters in the participating units. These assessments evaluated catheter condition, maintenance practices, dressing integrity, use of securement devices, and signs of local infection (using the Maddox scale), and also recorded whether the catheter had been used within the preceding 24 hours. All information was systematically recorded in a centralized electronic database, which facilitated tracking of adherence and correlation with catheter-related bacteremia incidence rates during the post-intervention period. Post-intervention period (12 months): Catheter-related bacteremia incidence continued to be monitored throughout the post-intervention period, allowing for correlation with observed practices. In parallel, adherence to the implemented methodology was assessed through direct, structured observations conducted by the project investigators, using a standardized checklist specifically developed for this purpose. A minimum of 20 catheter insertions were directly observed in each participating unit to evaluate aseptic technique during insertion, including hand hygiene, skin antisepsis, use of personal protective equipment, and proper dressing application. Additionally, during each month of the post-intervention period, at least 10 previously inserted catheters were assessed per unit. These follow-up evaluations included: compliance with maintenance protocols (e.g., hand hygiene during access, dressing integrity and fixation), the presence of devices or extensions, signs of local inflammation or infection assessed using the Maddox scale and documentation of whether the catheter had been used within the preceding 24 hours. These assessments aimed to monitor both adherence to best practices and ongoing appropriateness of catheter use. Definitions The diagnosis of catheter-related bacteremia (CRB) followed VINCat criteria (6) and required: Detection of bacterial or fungal growth from at least one peripheral blood culture in a patient with a venous catheter. For typical skin colonizers, two positive blood cultures were necessary. Presence of clinical signs of infection (e.g., fever, chills, or hypotension) without an alternative source, with the catheter suspected as the origin. Additionally, diagnosis required fulfilment of at least one of the following: Quantitative (>10³ CFU) or semi-quantitative (>15 CFU) culture of the catheter tip yielding the same microorganism as the peripheral blood culture. Positive quantitative blood cultures demonstrating a differential time to positivity >2 hours between catheter-drawn and peripheral blood samples. Presence of inflammatory signs or purulent discharge at the insertion site or along the subcutaneous tunnel of a venous catheter. Clinical improvement following catheter removal or appropriate antibiotic therapy when other diagnostic criteria could not be fully met. For the clinical diagnosis of PVC-BSI, the presence of signs of phlebitis is required (induration, pain or signs of inflammation at the insertion point or the catheter route). Maddox scale: used to assess PVC sites. It ranges from Grade 0 (no signs of inflammation) to Grade 4 (severe local infection). The scale is defined as follows: Grade 0: normal appearance; Grade 1: slight redness or discomfort; Grade 2: redness and pain; Grade 3: inflammatory signs (swelling, induration); Grade 4: signs of infection (e.g., purulence, extensive erythema). Statistical Analysis Categorical variables were summarized using absolute frequencies and percentages. Continuous variables were described using either the mean and standard deviation or the median and interquartile range, according to the underlying data distribution. CRB incidence rates were calculated per 1,000 hospital stays, and results were aggregated over three-month periods. Temporal trends and the effects of the intervention were assessed using Poisson regression models, incorporating an offset for the total number of hospital stays. Model assumptions were verified prior to conducting analyses. In addition, annual CRB incidence rates observed in previous years were compared to those predicted by the Poisson model. Funnel plots were employed to evaluate variability in CRB rates across participating hospitals during the study and post-study periods. Multilevel Poisson regression models including center as a random effect to account for potential clustering were explored as a sensitivity analysis For all estimators, 95% confidence intervals were calculated where appropriate. A p-value of <0.05 was considered statistically significant. Statistical analyses were performed using R software (version 4.1.0; The R Project for Statistical Computing; https://www.r-project.org) for Windows. Ethics: The study received approval from the Ethics Committee of Fundació Parc Taulí (Reference No. 20215024). Patient consent was not necessary for this study. Results Description of Catheters During the Intervention Period During the intervention period, a total of 7,737 catheters were inserted in 4,557 patients admitted to the participating units, and monitored from insertion to removal, with a median dwell time of 3.0 days (interquartile range [IQR]: 2–5 days). Among the patients, 1,688 (37%) required the insertion of more than one catheter during their admission. Catheters were inserted predominantly in medical wards (72%) and surgical wards (28%). The median age of patients was 73 years; 12% had diabetes mellitus, 6.2% had active neoplasia, 11% had undergone surgery during their admission, and 2.6% had been previously admitted to the intensive care unit. The majority of vascular devices were short peripheral catheters (6,969; 90.1%), followed by midlines (507; 6.6%), peripherally inserted central venous catheters (PICVC) (244; 3.2%), and central venous catheters (CVC) (17; 0.2%), three of which were femoral insertions. In terms of material composition, 173 (5.1%) catheters were made of third-generation polyurethane, while the remainder were of standard polyurethane. None of the central venous catheters used during the study period were antibiotic-impregnated. Most devices (7,673; 99%) were inserted in the arm, forearm, or hand and were primarily used for medication administration (7,100; 98%). Adherence to the recommended measures during the intervention was high: Hand hygiene with alcohol-based products was achieved in 99.6% of insertions. Skin antisepsis was performed in 99.9% (62.4% with alcoholic chlorhexidine, 37.5% with 70% alcohol). Transparent dressings were used in 98% of cases. A neutral-pressure bioconnector was utilized in 62.1%, an attached extension set in 25%, and three-way taps were avoided in 65.3% of cases. Use of femoral access was avoided in more than 99% of insertions. Changes in CRB Incidence Over Time During the study periods, a total of 40, 12, and 23 CRB episodes were diagnosed in the pre-intervention, intervention, and post-intervention periods, respectively (Fig. 1 ). Consequently, the incidence rates of CRB were 0.22, 0.16, and 0.13 per 1,000 hospital stays, respectively (Table 1 ). Table 1 Trimester incidence rates and hospital stays across the three study periods. Poisson model assessing the impact of the intervention on catheter-related bacteremia incidence. Months Pre-intervention Intervention Post-intervention CRB Stays Incidence rate x 1000 CRB Stays Incidence rate x 1000 CRB Stays Incidence rate x 1000 1–3 14 45,415 0.31 8 41,356 0.19 5 42,531 0.12 4–6 9 47,219 0.19 4 33,888 0.12 9 46,666 0.19 7–9 7 41,903 0.17 4 44,339 0.09 10–12 10 48,738 0.21 5 44,310 0.11 Total 40 183,275 0.22 12 75,244 0.16 23 177,846 0.13 Incidence rate expressed as CRB per 1,000 hospital stays. CRB: catheter-related bacteremia. Poisson regression modelling demonstrated that the CRB incidence rate during the post-intervention period was significantly lower compared to the pre-intervention period (incidence rate ratio [IRR] 0.59; 95% CI: 0.35–0.98) (Table 2 ). Table 2 Poisson model assessing the impact of the intervention on catheter-related bacteremia incidence. Incidence Rate Ratio Standard Error 95% CI p-value Intercept 0.00 0.00 0.00–0.00 < 0.001 Intervention vs Pre-intervention 0.73 0.24 0.37–1.35 0.341 Post-intervention vs Pre-intervention 0.59 0.16 0.35–0.98 0.046 ● Observations: 10 ● Nagelkerke R²: 0.575 ● AIC: 48.921 Furthermore, the previously observed upward trend in CRB incidence reversed during the intervention and post-intervention periods (Supplementary Fig. 2). Funnel plots assessing the incidence rates of catheter-related bacteremia (CRB) per 1,000 hospital stays across hospital-trimester observations during the intervention and post-intervention periods showed no hospitals with incidence rates falling outside the 95% confidence limits, suggesting consistent performance across participating centers (Supplementary Figs. 3 and 4). Adherence to the Intervention During the Post-Intervention Period During the post-intervention period, 406 observations of catheter insertions were recorded. The majority of devices inserted were PVCs (82%), followed by midlines (15.4%) and PICVCs (2.49%). Adherence to recommended practices included: Appropriate hand hygiene in 97.5% of procedures. Non-sterile gloves were used in 247 cases, while sterile gloves were used in 153 insertions (37.7%). Appropriate dressing and skin antisepsis were observed in all cases (98.6% with alcohol-based chlorhexidine and 0.74% with 70% alcohol). An attached extension set was used in 69.2% of cases, and a neutral-pressure bioconnector in 79.1%. Three-way taps were used in 13.8% of insertions. Among 1,718 catheters observed, 91.3% had been used within the preceding 24 hours. The insertion site was deemed appropriate in 91% of cases, as assessed by the Maddox scale: Grade 0 in the vast majority, Grade 1 in 31 cases (1.83%), Grade 2 in 9 cases (0.53%), Grade 4 in one case. Discussion Catheter-related bacteremia (CRB) surveillance programs continue to highlight this issue as a significant concern within contemporary hospital settings (12). This is particularly troubling given that CRB is among the most preventable nosocomial infections (13). Recent studies indicate an increasing incidence of infection associated with peripheral catheters inserted in conventional hospital wards (11), underscoring the urgent need for research focused on developing specific CRB prevention strategies targeting peripheral catheters in these settings. Implementing sustainable strategies to facilitate behavioral change in infection prevention practices remains a current priority. Notably, evidence-based recommendations may take up to two decades to achieve full integration into clinical practice (14). Our study demonstrates that applying a bundle of evidence-based recommendations within conventional hospital wards can significantly reduce CRB incidence. Overall, adherence to the proposed measures was high; however, lower compliance was noted for two key interventions: the use of neutral-pressure bioconnectors (62%) and attached extension sets (25%). Initially developed to reduce needlestick injuries among healthcare workers, needleless connectors were later found to be associated with increased CRB rates due to inadequate disinfection practices. It is now well established that proper disinfection of needleless connectors reduces CRB incidence compared to three-way stopcocks (15). The use of attached extension sets may also offer advantages in preventing catheter-related complications, including infection. These devices can minimize mechanical stress at the insertion site by providing greater mobility and reducing direct manipulation of the catheter hub, a recognized route for microbial entry (16). Although robust evidence, is lacking, expert consensus and clinical guidelines advocate for their use as part of best-practice bundles for peripheral venous catheter (PVC) management (17). Further studies are warranted to clarify their impact on bloodstream infection rates; however, in the interim, their use appears to be a reasonable and pragmatic recommendation. Structured educational programs are required to continuously deliver, monitor, and evaluate healthcare professionals' knowledge regarding catheter characteristics, insertion and maintenance procedures, infection prevention measures, and signs and symptoms of infection (18,19). Although maintaining high standards of practice over time in conventional wards is challenging, effective CRB prevention is associated with improved patient outcomes and reduced healthcare costs (20). Prevention programs have been particularly successful within intensive care units (9), where clinical workflows tend to be more standardized and care is often delivered by smaller, well-coordinated teams. As previously noted, a deeper understanding of the specific epidemiology and preventive needs in conventional wards is likely essential for implementing effective interventions and achieving similar outcomes (21). The challenges associated with implementing such programs in standard wards likely explain the inconsistent results observed to date. Importantly, interventions have generally been more effective in preventing central line-associated bloodstream infections than infections associated with PVCs (10,22–24). This finding is particularly significant given that PVCs are the most commonly used vascular access devices in clinical practice, as also observed in our study. Nonetheless, a substantial and sustained reduction in CRB incidence was achieved following the intervention, demonstrating that, with adequate resource allocation, effective CRB prevention strategies can be successfully implemented in conventional hospital units. This study has several limitations. This study has several limitations. First, although standardized definitions of catheter-related bacteremia (CRB) were used, we acknowledge that the fifth diagnostic criterion is inherently more subjective and less specific, which may introduce variability in case ascertainment. Second, catheter-days could not be calculated consistently across the three study periods, as catheter insertion and removal dates were not routinely recorded outside the intervention phase. As a result, incidence rates were calculated using hospital stays as the denominator, which may limit comparability with other surveillance systems that use catheter-days. Third, the selection of participating units was left to the discretion of each hospital, without predefined eligibility criteria. This may have introduced selection bias, as centers may have chosen units with stronger infection control engagement or more stable staffing. Fourth, the study was conducted in a single region (Catalonia), which benefits from a well-established and harmonized surveillance system. While this enhances the internal validity of the study, it may limit generalizability to settings with different infrastructures or IPC policies. Fifth, the study periods were of unequal duration: both the pre- and post-intervention phases lasted 12 months, whereas the intervention phase was limited to 6 months. Although this shorter period may reduce the precision of effect estimates, extending it further would have compromised comparability across timeframes. A longer follow-up study is currently underway to evaluate the durability of the intervention's impact. Sixth, the analysis relied on aggregated data, and it was therefore not possible to adjust for patient- or hospital-level covariates such as comorbidity burden, age, or catheter type. This may have limited the ability to fully control for confounding factors. Seventh, we could not adjust for seasonality. However, most hospitals completed the intervention by June 2022, which coincided with the onset of a new COVID-19 wave in Catalonia. It has been previously documented that COVID-19 surges negatively impact CRB incidence due to healthcare system strain (25). Thus, the sustained reduction in CRB rates observed in the post-intervention period—despite this unfavorable context—supports the robustness of our findings. Eighth, healthcare providers’ awareness of their participation in an intervention study may have influenced their behavior (Hawthorne effect), potentially affecting the generalizability of the results to routine clinical practice. However, previous studies have shown that the implementation of structured surveillance and infection control programs alone can lead to meaningful reductions in nosocomial infection rates (26). Ninth, adherence to the catheter insertion protocol during the intervention period was self-reported by clinical staff through a structured checklist, rather than being directly observed by the study investigators. Although training was provided, this may have introduced variability in reporting. In addition, a direct comparison of adherence across the three study periods was not feasible, since no adherence data were collected in the pre-intervention phase, and different monitoring strategies were applied during the intervention and post-intervention phases. Despite these limitations, this multicenter study demonstrates that a structured, evidence-based intervention targeting venous catheter insertion and maintenance in conventional hospital wards can lead to a significant reduction in CRB incidence. The study highlights the feasibility of implementing standardized practices outside of critical care settings, with potential implications for national and international infection control strategies aimed at improving patient safety and reducing preventable bloodstream infections. Future research should focus on identifying the most effective strategies to improve adherence to evidence-based practices in conventional hospital wards and evaluate their long-term impact on patient safety and healthcare resource utilization. To achieve broader and sustained impact, the development of national policies and guidelines specifically tailored to peripheral catheter management in non-critical care settings is strongly recommended. Declarations Author contributions: Conceptualization: OG, Methodology: OG, JP, Data collection: MO, ML-S, MA, VP, MV, AH, MJG-Q, XG-A, AM, MP, EJ-M, DD, AG-G, SG-C, JLF-M, MG-L, SA-V, YA, LG, EG-I, TM-S, MV-O, JG-G, CP-N, MG. Formal Analysis and interpretation: OG, MO, ML-S, MA, VP, MV, AH, MJG-Q, XG-A, AM, MP, EJ-M, DD, AG-G Writing – original draft preparation: OG. Writing – review and editing: OG, MO, ML-S, MA, VP, MV, AH, MJG-Q, XG-A, AM, MP, EJ-M, DD, AG-G Funding acquisition: OG. All authors have read and approved the final version of the manuscript. None of the authors have conflicts of interest to declare. OG received a personal research grant from the Pla Estratègic de Recerca i Innovació en Salut (PERIS) 2019–2021 (Departament de Salut, Generalitat de Catalunya). This work was supported by the Spanish Ministry of Economics and Competitiveness (Instituto de Salud Carlos III, Project Number: PI20/01563). References European Center for Disease Prevention and Control. 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Supplementary Files SupplementalFiles.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 Apr, 2026 Reviews received at journal 07 Apr, 2026 Reviews received at journal 29 Mar, 2026 Reviews received at journal 17 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviewers invited by journal 05 Feb, 2026 Editor assigned by journal 09 Jan, 2026 Submission checks completed at journal 09 Jan, 2026 First submitted to journal 08 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8553085\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":588477720,\"identity\":\"6e2220a4-2566-4dd9-8b56-1f737a4ca73b\",\"order_by\":0,\"name\":\"Oriol Gasch\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYLACxgYbIMnccIAULWkSIBKkRYJYLYfBWhiI0sLPv/jxh587ztfxz0hsPMBQY1dHUIvkjGdmkr1nbktI3EgEOuxYMmFbDG4cMGNmbLstwQDSwtjATIyW458/M7adk5CHaKknQsv5HgNpxrYDEgYQLYcJa5GcwVMm2duWLLnxzMOGAwnHjks2ENLCz39884efbXb8cseTD3/4UFPNT9AWBokEJE4CDkVo1hwgStkoGAWjYBSMZAAAseNB7Nc2jY8AAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Infectious Diseases Service. Hospital Universitari Parc Taulí. Hospital de Sabadell – I3PT, Universitat Autònoma of Barcelona\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Oriol\",\"middleName\":\"\",\"lastName\":\"Gasch\",\"suffix\":\"\"},{\"id\":588477721,\"identity\":\"4a199ae7-1697-47c8-a042-630c61b3c39a\",\"order_by\":1,\"name\":\"Montserrat Ortega-Raya\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Parc Taulí, University of Barcelona\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Montserrat\",\"middleName\":\"\",\"lastName\":\"Ortega-Raya\",\"suffix\":\"\"},{\"id\":588477722,\"identity\":\"a742d485-e63d-4dba-b57c-31aba478e7ec\",\"order_by\":2,\"name\":\"Maria López-Sánchez\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Mútua de Terrassa.\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Maria\",\"middleName\":\"\",\"lastName\":\"López-Sánchez\",\"suffix\":\"\"},{\"id\":588477723,\"identity\":\"bb4d03b7-68ad-44fd-8d10-dcbc0a7e6042\",\"order_by\":3,\"name\":\"Marta Andrés\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Consorci Sanitari de Terrassa. Terrassa\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Marta\",\"middleName\":\"\",\"lastName\":\"Andrés\",\"suffix\":\"\"},{\"id\":588477724,\"identity\":\"e22641b0-7640-419e-a0ba-3625849d7e4e\",\"order_by\":4,\"name\":\"Virginia Pomar\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Santa Creu i Sant Pau\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Virginia\",\"middleName\":\"\",\"lastName\":\"Pomar\",\"suffix\":\"\"},{\"id\":588477727,\"identity\":\"68e3f32c-77eb-4fb0-89a3-7e9aed14b896\",\"order_by\":5,\"name\":\"Montserrat Vaqué\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital de Barcelona\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Montserrat\",\"middleName\":\"\",\"lastName\":\"Vaqué\",\"suffix\":\"\"},{\"id\":588477730,\"identity\":\"08cf8cf4-20de-430f-ac90-d67bea7e71af\",\"order_by\":6,\"name\":\"Ana Hornero\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Bellvitge University Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Ana\",\"middleName\":\"\",\"lastName\":\"Hornero\",\"suffix\":\"\"},{\"id\":588477732,\"identity\":\"63dae9ee-43d2-49fe-b5dc-f0128aec6a30\",\"order_by\":7,\"name\":\"Maria José García-Quesada\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Germans Trias i Pujol\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Maria\",\"middleName\":\"José\",\"lastName\":\"García-Quesada\",\"suffix\":\"\"},{\"id\":588477733,\"identity\":\"7fda0fd6-fdf3-40b1-906e-0c5bdd0e9e3f\",\"order_by\":8,\"name\":\"Xavier García-Alarcon\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari de Girona Doctor Josep Trueta\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Xavier\",\"middleName\":\"\",\"lastName\":\"García-Alarcon\",\"suffix\":\"\"},{\"id\":588477734,\"identity\":\"811bde75-b32c-4caf-8cad-bac7980478db\",\"order_by\":9,\"name\":\"Judith Peñafiel\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Bellvitge University Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Judith\",\"middleName\":\"\",\"lastName\":\"Peñafiel\",\"suffix\":\"\"},{\"id\":588477735,\"identity\":\"655c40c8-408b-4f52-8150-9b7dc5bbad85\",\"order_by\":10,\"name\":\"Anna Marron\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Parc Taulí, University of Barcelona\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Anna\",\"middleName\":\"\",\"lastName\":\"Marron\",\"suffix\":\"\"},{\"id\":588477736,\"identity\":\"870f8256-eab4-4b5e-8510-e5b2d6ffd7e7\",\"order_by\":11,\"name\":\"Marta Píriz\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Santa Creu i Sant Pau\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Marta\",\"middleName\":\"\",\"lastName\":\"Píriz\",\"suffix\":\"\"},{\"id\":588477737,\"identity\":\"2eb4a132-907a-42ae-a81f-8476623a89af\",\"order_by\":12,\"name\":\"Emili Jiménez Martínez\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Bellvitge University Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Emili\",\"middleName\":\"Jiménez\",\"lastName\":\"Martínez\",\"suffix\":\"\"},{\"id\":588477738,\"identity\":\"8ba89118-e9ab-40b9-bf85-54e35228bc9c\",\"order_by\":13,\"name\":\"Mª Dolors Domènech\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari de Girona Doctor Josep Trueta\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mª\",\"middleName\":\"Dolors\",\"lastName\":\"Domènech\",\"suffix\":\"\"},{\"id\":588477739,\"identity\":\"bbeb5cca-bc92-4e86-9ccf-953bdf5169be\",\"order_by\":14,\"name\":\"Aina Gomila-Granje\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Parc Taulí, University of Barcelona\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Aina\",\"middleName\":\"\",\"lastName\":\"Gomila-Granje\",\"suffix\":\"\"},{\"id\":588477740,\"identity\":\"e9dd4d97-553a-4498-b87e-afcc1ae6c0c3\",\"order_by\":15,\"name\":\"Sonia Gómez-Cordoba\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Parc Taulí, University of Barcelona\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sonia\",\"middleName\":\"\",\"lastName\":\"Gómez-Cordoba\",\"suffix\":\"\"},{\"id\":588477741,\"identity\":\"2a878fb1-fba0-4d92-9bc9-a800fd82bc19\",\"order_by\":16,\"name\":\"José Luis Fernández-Moreno\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Parc Taulí, University of Barcelona\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"José\",\"middleName\":\"Luis\",\"lastName\":\"Fernández-Moreno\",\"suffix\":\"\"},{\"id\":588477742,\"identity\":\"b50e737c-a5a9-474d-8fe7-6961fd78cc74\",\"order_by\":17,\"name\":\"Montserrat García-Lucas\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Parc Taulí, University of Barcelona\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Montserrat\",\"middleName\":\"\",\"lastName\":\"García-Lucas\",\"suffix\":\"\"},{\"id\":588477743,\"identity\":\"a892bcd0-698d-4db5-b7d6-5b69a0af5c4e\",\"order_by\":18,\"name\":\"Silvia Alvarez-Viciana\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Mútua de Terrassa.\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Silvia\",\"middleName\":\"\",\"lastName\":\"Alvarez-Viciana\",\"suffix\":\"\"},{\"id\":588477744,\"identity\":\"f94912e0-9b8d-4250-aed5-90f5098a59a7\",\"order_by\":19,\"name\":\"Yésika Angulo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Consorci Sanitari de Terrassa. Terrassa\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yésika\",\"middleName\":\"\",\"lastName\":\"Angulo\",\"suffix\":\"\"},{\"id\":588477745,\"identity\":\"634153ea-7c52-4035-a475-9e9d20eec6a0\",\"order_by\":20,\"name\":\"Laura Grau\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Consorci Sanitari de Terrassa. Terrassa\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Laura\",\"middleName\":\"\",\"lastName\":\"Grau\",\"suffix\":\"\"},{\"id\":588477747,\"identity\":\"5e4518e2-0dee-497e-b1b9-04e893d736f0\",\"order_by\":21,\"name\":\"Elena Gomez-Ibañez\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Santa Creu i Sant Pau\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Elena\",\"middleName\":\"\",\"lastName\":\"Gomez-Ibañez\",\"suffix\":\"\"},{\"id\":588477748,\"identity\":\"3d141f9e-d74b-42ef-becb-b81daf26a4c1\",\"order_by\":22,\"name\":\"Teresa Manzano-Sanchez\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital de Barcelona\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Teresa\",\"middleName\":\"\",\"lastName\":\"Manzano-Sanchez\",\"suffix\":\"\"},{\"id\":588477752,\"identity\":\"1978b923-112a-4d85-9719-6faa672aa38f\",\"order_by\":23,\"name\":\"Miriam Villalobos-Ortega\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital de Barcelona\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Miriam\",\"middleName\":\"\",\"lastName\":\"Villalobos-Ortega\",\"suffix\":\"\"},{\"id\":588477753,\"identity\":\"2da31f5b-e78c-4b7d-b104-7833c88f5a0a\",\"order_by\":24,\"name\":\"Jessica García-García\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Germans Trias i Pujol\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jessica\",\"middleName\":\"\",\"lastName\":\"García-García\",\"suffix\":\"\"},{\"id\":588477754,\"identity\":\"1d1e1308-7d16-4746-b780-5604e6a0a096\",\"order_by\":25,\"name\":\"Carolina Porta-Naharro\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Mútua de Terrassa.\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Carolina\",\"middleName\":\"\",\"lastName\":\"Porta-Naharro\",\"suffix\":\"\"},{\"id\":588477755,\"identity\":\"c0e2901c-255c-4814-893f-62c2c9743059\",\"order_by\":26,\"name\":\"Montserrat Giménez\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Hospital Universitari Germans Trias i Pujol\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Montserrat\",\"middleName\":\"\",\"lastName\":\"Giménez\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-01-08 15:24:01\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8553085/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8553085/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":102438475,\"identity\":\"5eda3c4e-5008-4b6c-86fe-be0e703e7de9\",\"added_by\":\"auto\",\"created_at\":\"2026-02-11 16:34:18\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":28613,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eTrimester evolution of catheter-related bacteremia (CRB) episodes and CRB incidence rate per 1,000 hospital stays.\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Onlinefloatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8553085/v1/0c59ebf9bc8506f3c02b8e1d.png\"},{\"id\":102438476,\"identity\":\"827a98b8-ae6f-4ee5-a80f-e261ab40049e\",\"added_by\":\"auto\",\"created_at\":\"2026-02-11 16:34:18\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":32826,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cstrong\\u003eAnnual evolution of catheter-related bacteremia (CRB) incidence rates at the participating units (2011–2022).\\u003c/strong\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Onlinefloatimage2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8553085/v1/e16ef8ee907ee0b1ab89ac24.png\"},{\"id\":102745586,\"identity\":\"18b52c39-5eef-4873-bcb9-91b9125a1173\",\"added_by\":\"auto\",\"created_at\":\"2026-02-16 08:52:09\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":951690,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8553085/v1/f7cd888a-9630-441d-855f-e0b91728d5b2.pdf\"},{\"id\":102438477,\"identity\":\"523d63e0-3d78-4732-9a61-e461a0622256\",\"added_by\":\"auto\",\"created_at\":\"2026-02-11 16:34:18\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":1321826,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementalFiles.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8553085/v1/4e0cd62389ecab007f01b1b7.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Successful multimodal intervention to prevent catheter-related bacteremia in conventional wards (PREVCATH)\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eThe utilization of vascular devices is integral to the management of hospitalized patients, frequently facilitating the administration of intravenous therapies, fluids, parenteral nutrition, and hemodialysis. Vascular catheters, notably peripheral and central vascular catheters (PVCs and CVCs), represent the most commonly employed devices in clinical practice, with reported prevalence rates of 50\\u0026ndash;70% and approximately 10%, respectively, among hospitalized patients (1,2).\\u003c/p\\u003e \\u003cp\\u003eCatheter failure remains a frequent and clinically significant issue, with failure rates ranging from 30% to 50% for PVCs and approximately 3% for CVCs. Failures may be mechanical (e.g., occlusion, dislodgement), infectious (e.g., catheter-related bacteremia [CRBs]), or thrombotic (e.g., catheter-related thrombosis). Such complications are associated with prolonged hospitalization, increased healthcare costs, and elevated risks of morbidity and mortality, thereby underscoring the urgent need for enhanced preventive strategies and management protocols (3).\\u003c/p\\u003e \\u003cp\\u003eAmong hospital-acquired infections, those associated with vascular catheters rank among the most prevalent, alongside surgical site infections, urinary tract infections, and hospital-acquired pneumonia. CRB represents the most severe catheter-associated complication, carrying an estimated mortality rate of approximately 25% when it is originated in a central-line (4). In addition, CRB significantly prolongs hospital stays and imposes substantial financial burdens, with each case of CVC-related bacteremia estimated to cost around \\u0026euro;31,381 (5).\\u003c/p\\u003e \\u003cp\\u003eCRBs account for approximately 25% of all nosocomial bacteremia s (6). Although incidence rates are higher within intensive care units (ICUs), the absolute number of CRB episodes is greater in conventional hospital wards. The incidence of CRB ranges from 0.5 episodes per 1,000 patient-days for PVCs to 2.7 episodes per 1,000 patient-days for CVCs (7).\\u003c/p\\u003e \\u003cp\\u003eOver the past two decades, the implementation of preventive bundles in ICUs\\u0026mdash;encompassing hand hygiene, chlorhexidine-based skin antisepsis, maximal barrier precautions during catheter insertion, daily evaluation of catheter necessity, and the avoidance of femoral access\\u0026mdash;has significantly reduced CRB incidence (8). The Spanish Bacteremia Zero initiative exemplifies such success (9). Nevertheless, similar reductions have not been achieved in conventional hospital wards, particularly concerning PVC- and PICC-related infections (10).\\u003c/p\\u003e \\u003cp\\u003eIn Catalonia, the VINCat program, initiated in 2006, aimed to reduce healthcare-associated infection rates through continuous active surveillance and the application of preventive interventions. CRB surveillance remains a central component of VINCat (6). Over the past decade, 8,049 CRB episodes meeting VINCat criteria were recorded, with an overall incidence declining from 0.28 to 0.21 episodes per 1,000 hospital stays between 2008 and 2018. This reduction was largely attributable to decreased CVC-related bacteremia s, whereas episodes linked to PVCs and PICCs have increased. Notably, this decline was observed exclusively within ICU settings, with no significant improvement detected in conventional hospital wards (11).\\u003c/p\\u003e \\u003cp\\u003eThe primary objective of this study was to assess the impact of a multimodal preventive program on catheter failure rates and CRB incidence within conventional hospitalization wards across several Spanish hospitals. Secondary objectives included the evaluation of long-term adherence to the preventive measures and their sustained clinical impact.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003ch3\\u003eStudy Design\\u003c/h3\\u003e\\n\\u003cp\\u003eThis prospective, multicenter interventional study was conducted across eight public healthcare system hospitals in Catalonia: Hospital de Bellvitge, Hospital de Terrassa, Hospital Parc Taul\\u0026iacute; de Sabadell, Hospital de Sant Pau, Hospital Josep Trueta de Girona, Hospital Germans Trias i Pujol, Hospital de Barcelona, and Hospital M\\u0026uacute;tua de Terrassa. Collectively, these centers account for approximately 950,000 hospital stays annually. Further details on the characteristics of the participating hospitals are provided in Supplementary Table 1.\\u003c/p\\u003e\\n\\u003cp\\u003eAt each participating hospital, the principal investigator (PI) was a member of the VINCat Group for Bloodstream and Vascular Catheter-Related Infections and formed part of the Infection Control Team. The Infection Control Team was responsible for ensuring methodological adherence and routinely monitored all CRB episodes identified via microbiology laboratory reporting.\\u003c/p\\u003e\\n\\u003ch3\\u003eStudy Population\\u003c/h3\\u003e\\n\\u003cp\\u003eIn each hospital, one to three conventional medical and surgical hospitalization units were selected for inclusion. All catheters inserted in patients admitted to these units were managed according to the study protocol. The study comprised three periods:\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003ePre-intervention period (12 months):\\u003c/strong\\u003e Usual preventive practices established at each center continued within the selected units. CRB episodes were recorded throughout this period. In addition, historical CRB incidence data (2009\\u0026ndash;2021) were collected to estimate the expected incidence during the intervention.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003eIntervention period (6 months):\\u003c/strong\\u003e The intervention phase was implemented during 2022 and lasted six months in each participating hospital. Each center initiated the intervention as soon as the necessary approvals and local infrastructure were in place. Most hospitals launched the intervention between January and February 2022, while one hospital began in May 2022.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eHealthcare professionals (physicians and nurses) in the participating units received initial training. Following catheter insertion, a checklist was completed to assess adherence to the insertion and maintenance bundles (Supplementary Figure 1), which included:\\u003c/p\\u003e\\n\\u003cp\\u003e(i) appropriate catheter type and insertion site selection;\\u003c/p\\u003e\\n\\u003cp\\u003e(ii) hand hygiene using alcohol-based hand rub;\\u003c/p\\u003e\\n\\u003cp\\u003e(iii) skin antisepsis with 2% chlorhexidine in alcohol;\\u003c/p\\u003e\\n\\u003cp\\u003e(iv) use of appropriate insertion materials;\\u003c/p\\u003e\\n\\u003cp\\u003e(v) daily inspection of the dressing and insertion site, with immediate removal of catheters no longer required or associated with complications.\\u003c/p\\u003e\\n\\u003cp\\u003eRelevant patient and catheter information was documented daily by the project investigators at each center using a structured electronic verification form. Adherence to infection prevention and control measures was monitored through checklists and daily catheter inspections. At the time of insertion, the attending nurse completed a standardized insertion checklist, documenting key aseptic practices such as hand hygiene, use of personal protective equipment, skin antisepsis, and dressing technique. These were not direct observations by project staff. In addition, members of the project team performed daily inspections of all catheters in the participating units. These assessments evaluated catheter condition, maintenance practices, dressing integrity, use of securement devices, and signs of local infection (using the Maddox scale), and also recorded whether the catheter had been used within the preceding 24 hours. All information was systematically recorded in a centralized electronic database, which facilitated tracking of adherence and correlation with catheter-related bacteremia incidence rates during the post-intervention period.\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003e\\u003cstrong\\u003ePost-intervention period (12 months):\\u003c/strong\\u003e Catheter-related bacteremia incidence continued to be monitored throughout the post-intervention period, allowing for correlation with observed practices. In parallel, adherence to the implemented methodology was assessed through direct, structured observations conducted by the project investigators, using a standardized checklist specifically developed for this purpose. A minimum of 20 catheter insertions were directly observed in each participating unit to evaluate aseptic technique during insertion, including hand hygiene, skin antisepsis, use of personal protective equipment, and proper dressing application. Additionally, during each month of the post-intervention period, at least 10 previously inserted catheters were assessed per unit. These follow-up evaluations included: compliance with maintenance protocols (e.g., hand hygiene during access, dressing integrity and fixation), the presence of devices or extensions, signs of local inflammation or infection assessed using the Maddox scale and documentation of whether the catheter had been used within the preceding 24 hours. These assessments aimed to monitor both adherence to best practices and ongoing appropriateness of catheter use.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003ch3\\u003eDefinitions\\u003c/h3\\u003e\\n\\u003cp\\u003eThe diagnosis of catheter-related bacteremia (CRB) followed VINCat criteria (6) and required:\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003eDetection of bacterial or fungal growth from at least one peripheral blood culture in a patient with a venous catheter. For typical skin colonizers, two positive blood cultures were necessary.\\u003c/li\\u003e\\n \\u003cli\\u003ePresence of clinical signs of infection (e.g., fever, chills, or hypotension) without an alternative source, with the catheter suspected as the origin.\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003eAdditionally, diagnosis required fulfilment of at least one of the following:\\u003c/p\\u003e\\n\\u003cul\\u003e\\n \\u003cli\\u003eQuantitative (\\u0026gt;10\\u0026sup3; CFU) or semi-quantitative (\\u0026gt;15 CFU) culture of the catheter tip yielding the same microorganism as the peripheral blood culture.\\u003c/li\\u003e\\n \\u003cli\\u003ePositive quantitative blood cultures demonstrating a differential time to positivity \\u0026gt;2 hours between catheter-drawn and peripheral blood samples.\\u003c/li\\u003e\\n \\u003cli\\u003ePresence of inflammatory signs or purulent discharge at the insertion site or along the subcutaneous tunnel of a venous catheter.\\u003c/li\\u003e\\n \\u003cli\\u003eClinical improvement following catheter removal or appropriate antibiotic therapy when other diagnostic criteria could not be fully met. For the clinical diagnosis of PVC-BSI, the presence of signs of phlebitis is required (induration, pain or signs of inflammation at the insertion point or the catheter route).\\u0026nbsp;\\u003c/li\\u003e\\n\\u003c/ul\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMaddox scale:\\u003c/strong\\u003e used to assess PVC sites. It ranges from Grade 0 (no signs of inflammation) to Grade 4 (severe local infection). The scale is defined as follows: Grade 0: normal appearance; Grade 1: slight redness or discomfort; Grade 2: redness and pain; Grade 3: inflammatory signs (swelling, induration); Grade 4: signs of infection (e.g., purulence, extensive erythema).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStatistical Analysis\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCategorical variables were summarized using absolute frequencies and percentages. Continuous variables were described using either the mean and standard deviation or the median and interquartile range, according to the underlying data distribution.\\u003c/p\\u003e\\n\\u003cp\\u003eCRB incidence rates were calculated per 1,000 hospital stays, and results were aggregated over three-month periods. Temporal trends and the effects of the intervention were assessed using Poisson regression models, incorporating an offset for the total number of hospital stays. Model assumptions were verified prior to conducting analyses.\\u003c/p\\u003e\\n\\u003cp\\u003eIn addition, annual CRB incidence rates observed in previous years were compared to those predicted by the Poisson model. Funnel plots were employed to evaluate variability in CRB rates across participating hospitals during the study and post-study periods.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eMultilevel Poisson regression models including center as a random effect to account for potential clustering were explored as a sensitivity analysis\\u003c/p\\u003e\\n\\u003cp\\u003eFor all estimators, 95% confidence intervals were calculated where appropriate. A p-value of \\u0026lt;0.05 was considered statistically significant. Statistical analyses were performed using R software (version 4.1.0; The R Project for Statistical Computing; https://www.r-project.org) for Windows.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics:\\u003c/strong\\u003e The study received approval from the Ethics Committee of Fundaci\\u0026oacute; Parc Taul\\u0026iacute; (Reference No. 20215024). Patient consent was not necessary for this study.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDescription of Catheters During the Intervention Period\\u003c/h2\\u003e \\u003cp\\u003eDuring the intervention period, a total of 7,737 catheters were inserted in 4,557 patients admitted to the participating units, and monitored from insertion to removal, with a median dwell time of 3.0 days (interquartile range [IQR]: 2\\u0026ndash;5 days). Among the patients, 1,688 (37%) required the insertion of more than one catheter during their admission. Catheters were inserted predominantly in medical wards (72%) and surgical wards (28%).\\u003c/p\\u003e \\u003cp\\u003eThe median age of patients was 73 years; 12% had diabetes mellitus, 6.2% had active neoplasia, 11% had undergone surgery during their admission, and 2.6% had been previously admitted to the intensive care unit.\\u003c/p\\u003e \\u003cp\\u003eThe majority of vascular devices were short peripheral catheters (6,969; 90.1%), followed by midlines (507; 6.6%), peripherally inserted central venous catheters (PICVC) (244; 3.2%), and central venous catheters (CVC) (17; 0.2%), three of which were femoral insertions. In terms of material composition, 173 (5.1%) catheters were made of third-generation polyurethane, while the remainder were of standard polyurethane. None of the central venous catheters used during the study period were antibiotic-impregnated. Most devices (7,673; 99%) were inserted in the arm, forearm, or hand and were primarily used for medication administration (7,100; 98%).\\u003c/p\\u003e \\u003cp\\u003eAdherence to the recommended measures during the intervention was high: Hand hygiene with alcohol-based products was achieved in 99.6% of insertions. Skin antisepsis was performed in 99.9% (62.4% with alcoholic chlorhexidine, 37.5% with 70% alcohol). Transparent dressings were used in 98% of cases. A neutral-pressure bioconnector was utilized in 62.1%, an attached extension set in 25%, and three-way taps were avoided in 65.3% of cases. Use of femoral access was avoided in more than 99% of insertions.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eChanges in CRB Incidence Over Time\\u003c/h3\\u003e\\n\\u003cp\\u003eDuring the study periods, a total of 40, 12, and 23 CRB episodes were diagnosed in the pre-intervention, intervention, and post-intervention periods, respectively (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Consequently, the incidence rates of CRB were 0.22, 0.16, and 0.13 per 1,000 hospital stays, respectively (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eTrimester incidence rates and hospital stays across the three study periods. Poisson model assessing the impact of the intervention on catheter-related bacteremia incidence.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"10\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMonths\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003ePre-intervention\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c7\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eIntervention\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c10\\\" namest=\\\"c8\\\"\\u003e \\u003cp\\u003ePost-intervention\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCRB\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eStays\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eIncidence rate x 1000\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eCRB\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eStays\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eIncidence rate x 1000\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eCRB\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eStays\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003eIncidence rate x 1000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e1\\u0026ndash;3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e45,415\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e41,356\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e42,531\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e4\\u0026ndash;6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e47,219\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e33,888\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e46,666\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.19\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e7\\u0026ndash;9\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41,903\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e4\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e44,339\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e10\\u0026ndash;12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e48,738\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e44,310\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e183,275\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e75,244\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e177,846\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e \\u003cp\\u003e0.13\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"10\\\"\\u003eIncidence rate expressed as CRB per 1,000 hospital stays. CRB: catheter-related bacteremia.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003ePoisson regression modelling demonstrated that the CRB incidence rate during the post-intervention period was significantly lower compared to the pre-intervention period (incidence rate ratio [IRR] 0.59; 95% CI: 0.35\\u0026ndash;0.98) (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePoisson model assessing the impact of the intervention on catheter-related bacteremia incidence.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eIncidence Rate Ratio\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eStandard Error\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e95% CI\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntercept\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.00\\u0026ndash;0.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eIntervention vs Pre-intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.73\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.37\\u0026ndash;1.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.341\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePost-intervention vs Pre-intervention\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.35\\u0026ndash;0.98\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.046\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e● Observations: 10\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e● Nagelkerke R\\u0026sup2;: 0.575\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"5\\\"\\u003e● AIC: 48.921\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eFurthermore, the previously observed upward trend in CRB incidence reversed during the intervention and post-intervention periods (Supplementary Fig.\\u0026nbsp;2). Funnel plots assessing the incidence rates of catheter-related bacteremia (CRB) per 1,000 hospital stays across hospital-trimester observations during the intervention and post-intervention periods showed no hospitals with incidence rates falling outside the 95% confidence limits, suggesting consistent performance across participating centers (Supplementary Figs.\\u0026nbsp;3 and 4).\\u003c/p\\u003e\\n\\u003ch3\\u003eAdherence to the Intervention During the Post-Intervention Period\\u003c/h3\\u003e\\n\\u003cp\\u003eDuring the post-intervention period, 406 observations of catheter insertions were recorded. The majority of devices inserted were PVCs (82%), followed by midlines (15.4%) and PICVCs (2.49%). Adherence to recommended practices included: Appropriate hand hygiene in 97.5% of procedures. Non-sterile gloves were used in 247 cases, while sterile gloves were used in 153 insertions (37.7%). Appropriate dressing and skin antisepsis were observed in all cases (98.6% with alcohol-based chlorhexidine and 0.74% with 70% alcohol). An attached extension set was used in 69.2% of cases, and a neutral-pressure bioconnector in 79.1%. Three-way taps were used in 13.8% of insertions. Among 1,718 catheters observed, 91.3% had been used within the preceding 24 hours. The insertion site was deemed appropriate in 91% of cases, as assessed by the Maddox scale: Grade 0 in the vast majority, Grade 1 in 31 cases (1.83%), Grade 2 in 9 cases (0.53%), Grade 4 in one case.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eCatheter-related bacteremia (CRB) surveillance programs continue to highlight this issue as a significant concern within contemporary hospital settings (12). This is particularly troubling given that CRB is among the most preventable nosocomial infections (13). Recent studies indicate an increasing incidence of infection associated with peripheral catheters inserted in conventional hospital wards (11), underscoring the urgent need for research focused on developing specific CRB prevention strategies targeting peripheral catheters in these settings. Implementing sustainable strategies to facilitate behavioral change in infection prevention practices remains a current priority. Notably, evidence-based recommendations may take up to two decades to achieve full integration into clinical practice (14).\\u003c/p\\u003e \\u003cp\\u003eOur study demonstrates that applying a bundle of evidence-based recommendations within conventional hospital wards can significantly reduce CRB incidence. Overall, adherence to the proposed measures was high; however, lower compliance was noted for two key interventions: the use of neutral-pressure bioconnectors (62%) and attached extension sets (25%).\\u003c/p\\u003e \\u003cp\\u003eInitially developed to reduce needlestick injuries among healthcare workers, needleless connectors were later found to be associated with increased CRB rates due to inadequate disinfection practices. It is now well established that proper disinfection of needleless connectors reduces CRB incidence compared to three-way stopcocks (15).\\u003c/p\\u003e \\u003cp\\u003eThe use of attached extension sets may also offer advantages in preventing catheter-related complications, including infection. These devices can minimize mechanical stress at the insertion site by providing greater mobility and reducing direct manipulation of the catheter hub, a recognized route for microbial entry (16). Although robust evidence, is lacking, expert consensus and clinical guidelines advocate for their use as part of best-practice bundles for peripheral venous catheter (PVC) management (17). Further studies are warranted to clarify their impact on bloodstream infection rates; however, in the interim, their use appears to be a reasonable and pragmatic recommendation.\\u003c/p\\u003e \\u003cp\\u003eStructured educational programs are required to continuously deliver, monitor, and evaluate healthcare professionals' knowledge regarding catheter characteristics, insertion and maintenance procedures, infection prevention measures, and signs and symptoms of infection (18,19). Although maintaining high standards of practice over time in conventional wards is challenging, effective CRB prevention is associated with improved patient outcomes and reduced healthcare costs (20).\\u003c/p\\u003e \\u003cp\\u003ePrevention programs have been particularly successful within intensive care units (9), where clinical workflows tend to be more standardized and care is often delivered by smaller, well-coordinated teams. As previously noted, a deeper understanding of the specific epidemiology and preventive needs in conventional wards is likely essential for implementing effective interventions and achieving similar outcomes (21). The challenges associated with implementing such programs in standard wards likely explain the inconsistent results observed to date. Importantly, interventions have generally been more effective in preventing central line-associated bloodstream infections than infections associated with PVCs (10,22\\u0026ndash;24). This finding is particularly significant given that PVCs are the most commonly used vascular access devices in clinical practice, as also observed in our study.\\u003c/p\\u003e \\u003cp\\u003eNonetheless, a substantial and sustained reduction in CRB incidence was achieved following the intervention, demonstrating that, with adequate resource allocation, effective CRB prevention strategies can be successfully implemented in conventional hospital units.\\u003c/p\\u003e \\u003cp\\u003eThis study has several limitations. This study has several limitations. First, although standardized definitions of catheter-related bacteremia (CRB) were used, we acknowledge that the fifth diagnostic criterion is inherently more subjective and less specific, which may introduce variability in case ascertainment. Second, catheter-days could not be calculated consistently across the three study periods, as catheter insertion and removal dates were not routinely recorded outside the intervention phase. As a result, incidence rates were calculated using hospital stays as the denominator, which may limit comparability with other surveillance systems that use catheter-days. Third, the selection of participating units was left to the discretion of each hospital, without predefined eligibility criteria. This may have introduced selection bias, as centers may have chosen units with stronger infection control engagement or more stable staffing. Fourth, the study was conducted in a single region (Catalonia), which benefits from a well-established and harmonized surveillance system. While this enhances the internal validity of the study, it may limit generalizability to settings with different infrastructures or IPC policies. Fifth, the study periods were of unequal duration: both the pre- and post-intervention phases lasted 12 months, whereas the intervention phase was limited to 6 months. Although this shorter period may reduce the precision of effect estimates, extending it further would have compromised comparability across timeframes. A longer follow-up study is currently underway to evaluate the durability of the intervention's impact. Sixth, the analysis relied on aggregated data, and it was therefore not possible to adjust for patient- or hospital-level covariates such as comorbidity burden, age, or catheter type. This may have limited the ability to fully control for confounding factors. Seventh, we could not adjust for seasonality. However, most hospitals completed the intervention by June 2022, which coincided with the onset of a new COVID-19 wave in Catalonia. It has been previously documented that COVID-19 surges negatively impact CRB incidence due to healthcare system strain (25). Thus, the sustained reduction in CRB rates observed in the post-intervention period\\u0026mdash;despite this unfavorable context\\u0026mdash;supports the robustness of our findings. Eighth, healthcare providers\\u0026rsquo; awareness of their participation in an intervention study may have influenced their behavior (Hawthorne effect), potentially affecting the generalizability of the results to routine clinical practice. However, previous studies have shown that the implementation of structured surveillance and infection control programs alone can lead to meaningful reductions in nosocomial infection rates (26). Ninth, adherence to the catheter insertion protocol during the intervention period was self-reported by clinical staff through a structured checklist, rather than being directly observed by the study investigators. Although training was provided, this may have introduced variability in reporting. In addition, a direct comparison of adherence across the three study periods was not feasible, since no adherence data were collected in the pre-intervention phase, and different monitoring strategies were applied during the intervention and post-intervention phases.\\u003c/p\\u003e \\u003cp\\u003eDespite these limitations, this multicenter study demonstrates that a structured, evidence-based intervention targeting venous catheter insertion and maintenance in conventional hospital wards can lead to a significant reduction in CRB incidence. The study highlights the feasibility of implementing standardized practices outside of critical care settings, with potential implications for national and international infection control strategies aimed at improving patient safety and reducing preventable bloodstream infections.\\u003c/p\\u003e \\u003cp\\u003eFuture research should focus on identifying the most effective strategies to improve adherence to evidence-based practices in conventional hospital wards and evaluate their long-term impact on patient safety and healthcare resource utilization. To achieve broader and sustained impact, the development of national policies and guidelines specifically tailored to peripheral catheter management in non-critical care settings is strongly recommended.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eConceptualization: OG, Methodology: OG, JP, Data collection: MO, ML-S, MA, VP, MV, AH, MJG-Q, XG-A, AM, MP, EJ-M, DD, AG-G, SG-C, JLF-M, MG-L, SA-V, YA, LG, EG-I, TM-S, MV-O, JG-G, CP-N, MG. Formal Analysis and interpretation: OG, MO, ML-S, MA, VP, MV, AH, MJG-Q, XG-A, AM, MP, EJ-M, DD, AG-G Writing – original draft preparation: OG. Writing – review and editing: OG, MO, ML-S, MA, VP, MV, AH, MJG-Q, XG-A, AM, MP, EJ-M, DD, AG-G Funding acquisition: OG.\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors have read and approved the final version of the manuscript. None of the authors have conflicts of interest to declare.\\u003c/p\\u003e\\n\\u003cp\\u003eOG received a personal research grant from the Pla Estratègic de Recerca i Innovació en Salut (PERIS) 2019–2021 (Departament de Salut, Generalitat de Catalunya).\\u003c/p\\u003e\\n\\u003cp\\u003eThis work was supported by the Spanish Ministry of Economics and Competitiveness (Instituto de Salud Carlos III, Project Number: PI20/01563).\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eEuropean Center for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals \\u0026ndash; ECDC PPS validation protocol version 3.1.2 [Internet]. Stockholm: ECDC; 2019 [cited 2025 Apr 11]. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/PPS-HAI-AMR-protocol.pdf\\u003c/li\\u003e\\n\\u003cli\\u003eEstudio EPINE-EPPS n\\u0026ordm;29: 2018. Informe Espa\\u0026ntilde;a. Prevalencia de infecciones relacionadas con la asistencia sanitaria y comunitarias y uso de antimicrobianos en hospitales de agudos [Internet]. 2018 [cited 2025 Apr 11]. Available from: https://www.epine.es/docs/public/reports/esp/2018%20EPINE%20Informe%20Espa%C3%B1a.pdf\\u003c/li\\u003e\\n\\u003cli\\u003eTeja B, Bosch NA, Diep C, et al. Complication rates of central venous catheters: a systematic review and meta-analysis. JAMA Intern Med. 2024 May 1;184(5):474\\u0026ndash;82.\\u003c/li\\u003e\\n\\u003cli\\u003eStevens V, Edmond M, Thrupp L. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect. 2014;20(4):O318\\u0026ndash;24.\\u003c/li\\u003e\\n\\u003cli\\u003eServei Catal\\u0026agrave; de la Salut. Programa VINCat [Internet]. 2025 [cited 2025 Apr 11]. Available from: https://catsalut.gencat.cat/ca/proveidors-professionals/vincat/programa/\\u003c/li\\u003e\\n\\u003cli\\u003eWisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):309\\u0026ndash;17\\u003c/li\\u003e\\n\\u003cli\\u003eMaki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81(9):1159\\u0026ndash;71.\\u003c/li\\u003e\\n\\u003cli\\u003ePronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725\\u0026ndash;32.\\u003c/li\\u003e\\n\\u003cli\\u003ePalomar M, \\u0026Aacute;lvarez-Lerma F, Riera A, et al. Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience. Crit Care Med. 2013;41(10):2364\\u0026ndash;72.\\u003c/li\\u003e\\n\\u003cli\\u003eFreixas N, Bella F, Lim\\u0026oacute;n E, Pujol M, Almirante B, Gudiol F. Impact of a catheter care bundle on catheter-related bloodstream infection in non-ICU patients. Clin Microbiol Infect. 2013;19(9):838\\u0026ndash;44.\\u003c/li\\u003e\\n\\u003cli\\u003eBadia-Cebada L, Pe\\u0026ntilde;afiel J, Saliba P, et al. Trends in the epidemiology of catheter-related bloodstream infections; towards a paradigm shift, Spain, 2007 to 2019. Euro Surveill. 2022;27(19):pii=2100610. \\u003c/li\\u003e\\n\\u003cli\\u003eCenters for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections [Internet]. Atlanta (GA): US Department of Health and Human Services; 2011 [cited 2025 Apr 11]. Available from: https://www.cdc.gov/infection-control/guidelines/bsi/index.html\\u003c/li\\u003e\\n\\u003cli\\u003eO\\u0026apos;Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162\\u0026ndash;93.\\u003c/li\\u003e\\n\\u003cli\\u003eTrivedi KK, Schaffzin JK, Deloney VM, et al. Implementing strategies to prevent infections in acute-care settings. Infect Control Hosp Epidemiol. 2023 Aug;44(8):1232\\u0026ndash;46 \\u003c/li\\u003e\\n\\u003cli\\u003eCasey AL, Burnell S, Whinn H, Worthington T, Faroqui M H, Elliott TSJ. A prospective clinical trial to evaluate the microbial barrier of a needleless connector. J Hosp Infect. 2007 Mar;65(3):212-8.\\u003c/li\\u003e\\n\\u003cli\\u003eGorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice. J Infus Nurs. 2023;46(1S Suppl 1):S1\\u0026ndash;224.\\u003c/li\\u003e\\n\\u003cli\\u003eZingg W, Barton A, Bitmead J, et al. Best practice in the use of peripheral venous catheters: A scoping review and expert consensus. Infect Prev Pract. 2023;5(2):100271.\\u003c/li\\u003e\\n\\u003cli\\u003eYilmaz G, Caylan R, Aydin K, Koksal I. Effect of education on the rate of and the understanding of peripheral intravenous catheter-related complications in nurses. Infect Control Hosp Epidemiol. 2007;28(6):689\\u0026ndash;94. \\u003c/li\\u003e\\n\\u003cli\\u003eMoureau N, Sigl G, Hill M. Reducing bloodstream infections and improving patient outcomes: evidence for a care bundle approach. Br J Anaesth. 2013;110(4):347\\u0026ndash;56.\\u003c/li\\u003e\\n\\u003cli\\u003ePittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA. 1994;271(20):1598\\u0026ndash;601. \\u003c/li\\u003e\\n\\u003cli\\u003eKallen AJ, Patel PR, O\\u0026apos;Grady NP. Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Clin Infect Dis. 2010 Aug 1;51(3):335-41\\u003c/li\\u003e\\n\\u003cli\\u003eO\\u0026apos;Neil C, Ball K, Wood H, Tan C, Leung V. A quality improvement initiative to improve central line maintenance in non-intensive care units. Can J Infect Control. 2016;31(1):19\\u0026ndash;24.\\u003c/li\\u003e\\n\\u003cli\\u003evan der Kooi T, Greeff SC, Weterings V, Wille JC, van den Hoogen A, van Mourik MS. Effect of bundle implementation on central line-associated bloodstream infections in non-ICU patients: Results from a national surveillance study. J Hosp Infect. 2023;131:27\\u0026ndash;33. doi:10.1016/j.jhin.2022.10.021.\\u003c/li\\u003e\\n\\u003cli\\u003ePoh BF, Yee ML, Tan TY, Goh WP, Lim JW, Liew YX. Sustaining a reduction in central line-associated bloodstream infections in general wards in a resource-limited setting. Am J Infect Control. 2020;48(5):546\\u0026ndash;52. doi:10.1016/j.ajic.2019.10.009.\\u003c/li\\u003e\\n\\u003cli\\u003eGasch O, Badia-Cebada L, Carmezim J, et al. Effects of the COVID-19 Pandemic on Incidence and Epidemiology of Catheter-Related Bacteremia, Spain. Emerg Infect Dis. 2022 Nov;28(11):2181-2189. DOI: 10.3201/eid2811.220547\\u003c/li\\u003e\\n\\u003cli\\u003eHaley RW, Culver DH, White JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985;121(2):182\\u0026ndash;205. \\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"antimicrobial-resistance-and-infection-control\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"aric\",\"sideBox\":\"Learn more about [Antimicrobial Resistance and Infection Control](http://aricjournal.biomedcentral.com/)\",\"snPcode\":\"13756\",\"submissionUrl\":\"https://submission.nature.com/new-submission/13756/3\",\"title\":\"Antimicrobial Resistance \\u0026 Infection Control\",\"twitterHandle\":\"@ARICJournal\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Catheter-related bacteremia, catheter failure, multimodal preventive intervention\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8553085/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8553085/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground: \\u003c/strong\\u003eCatheter-related bacteraemia (CRBs) are a major cause of healthcare-associated morbidity and mortality. Although preventive measures have reduced CRB incidence in intensive care units (ICUs), their impact in conventional hospital wards remains limited. This study evaluated a multimodal intervention programme to prevent CRB in non-ICU settings.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods: \\u003c/strong\\u003eWe conducted a prospective, multicentre interventional study across eight Spanish hospitals. Three periods were defined: (i) Pre-intervention (12 months), during which standard practices were maintained; (ii) Intervention (6 months), comprising staff training and implementation of insertion and maintenance bundles; and (iii) Post-intervention (12 months), during which outcomes were monitored. The incidence rate ratio (IRR) for CRB was analysed using Poisson regression models, with the total number of hospital stays as the offset.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults: \\u003c/strong\\u003eDuring the intervention, 7,737 vascular catheters were placed (mean dwell time: 3.0 days) in 4,557 patients across medical (72%) and surgical (28%) wards. Devices used were mainly short peripheral catheters (90.1%), followed by midlines (6.6%), peripherally inserted central catheters (3.2%), and central lines (0.2%), primarily for medication administration (98%).\\u003c/p\\u003e\\n\\u003cp\\u003eCRB incidence dropped from 0.22 per 1,000 hospital stays pre-intervention to 0.16 during intervention and 0.13 post-intervention. Poisson regression showed a significant CRB reduction after the intervention (IRR 0.59; 95% CI: 0.35–0.98).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions: \\u003c/strong\\u003eThe implementation of a multimodal preventive programme in conventional hospitalisation wards was associated with a significant and sustained reduction in CRB incidence over a 12-month follow-up period. These findings highlight the importance and feasibility of extending preventive strategies beyond the ICU setting.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Successful multimodal intervention to prevent catheter-related bacteremia in conventional wards (PREVCATH)\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-02-11 16:34:13\",\"doi\":\"10.21203/rs.3.rs-8553085/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-04-11T23:02:51+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-04-07T17:32:30+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-29T17:43:17+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-02-17T16:35:11+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"186501800489911248245797497358029676626\",\"date\":\"2026-02-09T08:18:23+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"99601268348208699211369331179789226745\",\"date\":\"2026-02-09T06:40:15+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"299049829328843653419181798977835173724\",\"date\":\"2026-02-08T21:05:27+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-02-06T02:21:55+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-01-09T05:47:11+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-01-09T05:46:25+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Antimicrobial Resistance \\u0026 Infection Control\",\"date\":\"2026-01-08T15:04:22+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"antimicrobial-resistance-and-infection-control\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"aric\",\"sideBox\":\"Learn more about [Antimicrobial Resistance and Infection Control](http://aricjournal.biomedcentral.com/)\",\"snPcode\":\"13756\",\"submissionUrl\":\"https://submission.nature.com/new-submission/13756/3\",\"title\":\"Antimicrobial Resistance \\u0026 Infection Control\",\"twitterHandle\":\"@ARICJournal\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC/SO AJ\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"18388d94-710d-4d6e-b999-f2ae8f89ee5b\",\"owner\":[],\"postedDate\":\"February 11th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-08T01:08:07+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-02-11 16:34:13\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8553085\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8553085\",\"identity\":\"rs-8553085\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}