Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection.
Central line-associated bloodstream infection (CLABSI) is the major complication of central venous catheters (CVC). The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88-0.96]; P<0.001) after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days) in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22). Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI.
Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland.
Walter
W
Zingg
Division of Anaesthesiology, University of Geneva Hospitals, Geneva, Switzerland.
Vanessa
V
Cartier
Division of Anaesthesiology, University of Geneva Hospitals, Geneva, Switzerland.
Cigdem
C
Inan
Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland; Nursing Department, University of Geneva Hospitals, Geneva, Switzerland.
Sylvie
S
Touveneau
Nursing Department, University of Geneva Hospitals, Geneva, Switzerland.
Michel
M
Theriault
Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland.
Angèle
A
Gayet-Ageron
Division of Anaesthesiology, University of Geneva Hospitals, Geneva, Switzerland.
François
F
Clergue
Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland; WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Didier
D
Pittet
Division of Anaesthesiology, University of Geneva Hospitals, Geneva, Switzerland.
Bernhard
B
Walder
D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000517:prevention & control*; D062905:Central Venous Catheters / Q000009:adverse effects*; D003428:Cross Infection / Q000517:prevention & control*; D004506:Education, Nursing; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement