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Implemented protocols in ICUs, SDUs reduce CLABSI rates
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The implementation of prevention and infection control measures established by the Institute for Healthcare Improvement led to a sustained decrease of central-line bloodstream infections in an ICU or step-down unit setting, according to recent findings.
Researchers conducted central-line associated bloodstream infection (CLABSI) surveillance at a 40-bed medical-surgical ICU and in two 40-bed step-down units (SDUs) in a tertiary care, private hospital in São Paulo. From January 2001 to December 2006, hospital personnel regularly implemented some CDC evidence-based practices, including sterile barrier precautions and 2% chlorhexidine application for skin antisepsis. From January 2007 to December 2012, during the study’s second phase, the hospital introduced the Institute for Healthcare Improvement (IHI) central-line bundle for all ICU and SDU patients for whom central venous lines were indicated. Infection control professionals conducted CLABSI surveillance based on the CDC’s guidelines.
The researchers calculated CLABSI incidence rates as the number of organisms isolated in bloodstream infections (BSIs) per 1,000 central-line days. They found that during the 12-year surveillance period, 3,380 CLABSIs with 397 organisms were detected. The rates of BSI dropped by 57.3% from phase 1 to phase 2. Central-line use in phase 1 was 0.48% compared with 0.54% in phase 2, with no difference in the types of venous catheters.
Microorganisms isolated during the earlier study phase included gram-positive organisms (46.9%), gram-negative organisms (35.3%), fungi (17.8%), Candida albicans (7.7%) and C. parapsilosis (4.6%). Phase 2 organisms included gram-positive organisms (42.4%), gram-negative organisms (38.1%), fungi (19.4%) and C. albicans (7.2%).
Mean incidence rates of gram-positive organisms, gram-negative rods and fungi also were reduced, but not significant.
“Our study provides insight into the influence of IHI central-line bundle on CLABSIs with a reduction in the incidence of pathogens but no change in the microbiological pattern over the 12-year surveillance period,” the researchers wrote. – by Jen Byrne
Disclosure: The researchers report no relevant financial disclosures.
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