Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience.
OBJECTIVE
Prevention of catheter-related bloodstream infection is a basic objective to optimize patient safety in the ICU. Building on the early success of a patient safety unit-based comprehensive intervention (the Keystone ICU project in Michigan), the Bacteremia Zero project aimed to assess its effectiveness after contextual adaptation at large-scale implementation in Spanish ICUs.


METHODS
Prospective time series.


METHODS
A total of 192 ICUs throughout Spain.


METHODS
All patients admitted to the participating ICUs during the study period (baseline April 1 to June 30, 2008; intervention period from January 1, 2009, to June 30, 2010).


METHODS
Engagement, education, execution, and evaluation were key program features. Main components of the intervention included a bundle of evidence-based clinical practices during insertion and maintenance of catheters and a unit-based safety program (including patient safety training and identification and analysis of errors through patient safety rounds) to improve the safety culture.


RESULTS
The number of catheter-related bloodstream infections was expressed as median and interquartile range. Poisson distribution was used to calculate incidence rates and risk estimates. The participating ICUs accounted for 68% of all ICUs in Spain. Catheter-related bloodstream infection was reduced after 16-18 months of participation (median 3.07 vs 1.12 episodes per 1,000 catheter-days, p<0.001). The adjusted incidence rate of bacteremia showed a 50% risk reduction (95% CI, 0.39-0.63) at the end of the follow-up period compared with baseline. The reduction was independent of hospital size and type.


CONCLUSIONS
Results of the Bacteremia Zero project confirmed that the intervention significantly reduced catheter-related bloodstream infection after large-scale implementation in Spanish ICUs. This study suggests that the intervention can also be effective in different socioeconomic contexts even with decentralized health systems.
1Intensive Care Unit, Hospital Universitari Arnau de Vilanova, Lleida, Universitat Autònoma de Barcelona, Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), Barcelona, Spain. 2Intensive Care Unit, Parc de Salut Mar, Universitat Autònoma de Barcelona, SEMICYUC, Barcelona, Spain. 3Intensive Care Unit, Hospital Universitari Vall d´Hebron, Barcelona, Spain. 4Patient Safety Programme, World Health Organization, Geneva, Switzerland. 5Statistics and Methodology Support Unit (USEM), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. 6Quality Agency of the National Health System, Spanish Ministry of Health, Social Policy and Equality, Madrid, Spain. 7Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, Johns Hopkins University School of Medicine, Bloomberg School of Public Health, and School of Nursing, Baltimore, MA.
Mercedes
M
Palomar
Francisco
F
Álvarez-Lerma
Alba
A
Riera
María Teresa
MT
Díaz
Ferrán
F
Torres
Yolanda
Y
Agra
Itziar
I
Larizgoitia
Christine A
CA
Goeschel
Peter J
PJ
Pronovost
D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D003131:Combined Modality Therapy; D003428:Cross Infection / Q000517:prevention & control; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061214:Patient Safety / Q000592:standards; D011159:Population Surveillance; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology