title: Impact of a multimodal intervention to reduce bloodstream infections related to vascular catheters in non-ICU wards: a multicentre study.
abstract: To determine the impact of a multimodal intervention designed to reduce the incidence of catheter-related bloodstream infections (CRBSIs) outside the ICU, we conducted a prospective, quasi-experimental, before-after intervention study in 11 hospitals participating in the VINCat programme in Catalonia, Spain. The intervention consists of: (i) an evidence-based bundle of practices relating to catheter insertion and maintenance; (ii) a training programme for healthcare workers; (iii) four point-prevalence surveys to track the status of the catheters; and (iv) feedback reports to the staff involved. The study included both central (CVC) and peripheral venous catheters (PVCs). Rates of CRBSI per 1000 patient-days were prospectively measured in 2009 (pre-intervention period) and 2010 (post-intervention period). The analysis included 1 191 843 patient-days in 2009 and 1 173 672 patient-days in 2010. The overall incidence of CRBSI decreased from 0.19 to 0.15 (p 0.04) and the incidence of CRBSI associated with a CVC decreased from 0.14 to 0.10 (p 0.004) after the intervention. The incidence in PVCs remained unchanged. There was a statistically significant improvement in the adequate maintenance of both CVCs and PVCs. Among the CRBSIs originating in PVCs, 61.8% appeared more than 72 h every insertion. There was a lower infection rate in the hospitals with a higher adherence to the recommendation to replace PVCs after 72 h. Our findings suggest that the implementation of intervention programmes similar to ours could have a major impact on patient safety by reducing the incidence of CRBSIs, and that routine replacement of PVCs might additionally prevent a significant number of bloodstream infections.
authors.affiliation: Hospital Universitari Mútua de Terrassa, Barcelona, Spain. nfreixas@mutuaterrassa.es
authors.forename: N
authors.initials: N
authors.lastname: Freixas
authors.forename: F
authors.initials: F
authors.lastname: Bella
authors.forename: E
authors.initials: E
authors.lastname: Limón
authors.forename: M
authors.initials: M
authors.lastname: Pujol
authors.forename: B
authors.initials: B
authors.lastname: Almirante
authors.forename: F
authors.initials: F
authors.lastname: Gudiol
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D016469:Fungemia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology
keywords: Catheter-related bloodstream infection; Staphylococcus aureus; central venous catheters; multimodal intervention; nosocomial bacteraemia; peripheral venous catheters