title: Effectiveness of a catheter-associated bloodstream infection bundle in a Thai tertiary care center: a 3-year study.
abstract: BACKGROUND
  We sought to determine the long-term impact of "bundled" infection control interventions on the rates of catheter-associated bloodstream infection (CA-BSI) in a middle-income country.
  
  
  METHODS
  A 500-bed tertiary care center in Thailand.
  
  
  METHODS
  A 3-year, hospital-wide, prospective quasi-experimental study was conducted for 1 year before the intervention (period 1), 1 year after implementation of the CA-BSI bundle (period 2), and at a 1-year follow-up after the intervention with intensified hand hygiene promotion (period 3).
  
  
  RESULTS
  In period 1, 88 episodes of CA-BSI (14 cases per 1000 catheter-days) were recorded. During period 2, the CA-BSI rate decreased by 54.1 % (6.4 cases per 1000 catheter-days; P <.001). Compared with period 1 (8% adherence), hand hygiene adherence was improved in period 2 (24%; P <.001) and period 3 (54%; P <.001). The CA-BSI rate was further decreased by 78% (1.4 cases per 1000 catheter-days; P <.001) during period 3. Notably, no CA-BSIs were seen in 6 of the 12 months (50%) of period 3. Compared with period 1, the mean number of catheter-days was significantly reduced in period 2 (4.9 +/- 1.5 days; P <.001) and period 3 (4.1 +/- 1.1 days; P <.001).
  
  
  CONCLUSIONS
  Bundled infection control practices are feasible and effective in sustaining reduced incidence of CA-BSI in patients with central venous catheters in a resource-limited setting.
authors.affiliation: Division of Infectious Diseases and Infection Control, Thammasat University Hospital, Pratumthani, Thailand. anapisarn@yahoo.com
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: Kanokporn
authors.initials: K
authors.lastname: Thongphubeth
authors.forename: Chananart
authors.initials: C
authors.lastname: Yuekyen
authors.forename: David K
authors.initials: DK
authors.lastname: Warren
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013785:Thailand; D055815:Young Adult