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


CONCLUSIONS
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.
Marra
Alexandre R
AR
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. alexmarra@einstein.br
Cal
Ruy Guilherme Rodrigues
RG
Durão
Marcelino Souza
MS
Correa
Luci
L
Guastelli
Luciana Reis
LR
Moura
Denis Faria
DF
Edmond
Michael B
MB
Dos Santos
Oscar Fernando Pavão
OF
D016470:Bacteremia / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000382:microbiology*; D016469:Fungemia / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units