Impact of a program to prevent central line-associated bloodstream infection in the zero tolerance era

• Published in: American journal of infection control 2010-08, Vol.38 (6), p.434-439
• Main Authors: Marra, Alexandre R., MD, Cal, Ruy Guilherme Rodrigues, MD, Durão, Marcelino Souza, MD, Correa, Luci, MD, Guastelli, Luciana Reis, RN, Moura, Denis Faria, RN, Edmond, Michael B., MD, MPH, MPA, dos Santos, Oscar Fernando Pavão, MD
• Format: Article
• Language: English
• Subjects: Bacteremia - prevention & control; Bloodstream infection; Catheter-Related Infections - prevention & control; Catheterization, Central Venous - adverse effects; Catheters; Catheters, Indwelling - microbiology; central line bundle; central venous catheter; Disease control; epidemiology; Evidence-based medicine; Fungemia - prevention & control; Humans; Infection Control; Infection Control - methods; Infectious Disease; Intensive care; intensive care unit; Intensive Care Units; Intervention; Nosocomial infections; prevention; step-down unit; Studies; zero tolerance
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2009.11.012

Background Central line-associated bloodstream infection (CLABSI) is one of the most important health care-associated infections in the critical care setting. Methods A quasiexperimental study involving multiple interventions to reduce the incidence of CLABSI was conducted in a medical-surgical intensive care unit (ICU) and in 2 step-down units (SDUs). From March 2005 to March 2007 (phase 1 [P1]), some Centers for Disease Control and Prevention evidence-based practices were implemented. From April 2007 to April 2009 (P2), we intervened in these processes at the same time that performance monitoring was occurring at the bedside, and we implemented the Institute for Healthcare Improvement central line bundle for all ICU and SDU patients requiring central venous lines. Results The mean incidence density of CLABSI per 1000 catheter-days in the ICU was 6.4 in phase 1 and 3.2 in phase 2, P < .001. The mean incidence density of CLABSI per 1000 catheter-days in the SDUs was 4.1 in phase 1 and 1.6 in phase 2, P = .005. Conclusion These results suggest that reducing CLABSI rates in an ICU setting is a complex process that involves multiple performance measures and interventions that can also be applied to SDU settings.