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Open Access Highly Accessed Research article

Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit

José Francisco García-Rodríguez16*, Hortensia Álvarez-Díaz1, Laura Vilariño-Maneiro2, María Virginia Lorenzo-García3, Ana Cantón-Blanco4, Patricia Ordoñez-Barrosa5, Ana Isabel Mariño-Callejo1 and Pascual Sesma-Sánchez2

Author affiliations

1 Infectious Diseases Unit, Internal Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain

2 Internal Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain

3 Preventive Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain

4 Endocrinology Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain

5 Microbiology Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain

6 C/ San Amaro 10-12, 6° Derecha, 15403, Ferrol, La Coruña, Spain

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Citation and License

BMC Infectious Diseases 2013, 13:445  doi:10.1186/1471-2334-13-445

Published: 24 September 2013

Abstract

Background

Outside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted “bundle” approach in controlling CVC-ABSIs outside ICU.

Methods

From 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases.

Results

Prevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in last three years, showing a 63.1% decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95%CI: 0.04-0.91).

Conclusion

The rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.

Keywords:
Catheter; Bloodstreams; Infection control