title: Catheter-related bloodstream infection: burden of disease in a tertiary hospital.
abstract: BACKGROUND
  Surveillance programmes have become the most effective tool for controlling catheter-related bloodstream infections (CRBSI). However, few studies have investigated programmes covering all hospital settings.
  
  
  OBJECTIVE
  To describe the results of a control and prevention programme for CRBSI based on compliance with recommendations for insertion and maintenance, using annual burden of disease in a tertiary level hospital.
  
  
  METHODS
  A CRBSI control and prevention programme involving all hospital settings was implemented. The programme consisted of CRBSI surveillance, direct observation of insertion and maintenance of catheters to determine performance, and education for healthcare workers.
  
  
  RESULTS
  In total, 2043 short-term catheters were inserted in 1546 patients for 18,570 catheter-days, and 279 long-term catheters were inserted in 243 patients for 40,440 catheter-days. The annual incidence density was 5.98 (first semester 6.40, second semester 5.64) CRBSI per 1000 catheter-days for short-term catheters, and 0.57 (first semester 0.66, second semester 0.43) CRBSI per 1000 catheter-days for long-term catheters. One hundred and forty insertion procedures were observed, with an average insertion time of 13 (standard deviation 7) min. Compliance with recommendations was as follows: hand hygiene, 86.8%; use of alcoholic chlorhexidine solution for skin disinfection, 35.5%; use of mask, 93.4%; use of gloves, 98.7%; use of gown, 75.0%; use of sterile cloth, 93.8%; use of cap, 92.2%; bandage application, 62.7%; and use of aseptic technique, 89.5%. Forty-five maintenance procedures were observed, and compliance rates were as follows: hand hygiene, 42.1%; use of gloves, 78.1%; and port disinfection with alcoholic chlorhexidine solution, 32.5%.
  
  
  CONCLUSIONS
  The CRBSI control and prevention programme implemented at the study hospital has decreased the rate of CRBSI, provided important information about the total burden of disease, and revealed possible ways to improve interventions in the future.
authors.affiliation: Department of Preventive Medicine, Alicante University General Hospital, Alicante, Spain; Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Alicante University, Alicante, Spain.
authors.forename: H R
authors.initials: HR
authors.lastname: Martínez-Morel
authors.affiliation: Department of Preventive Medicine, Alicante University General Hospital, Alicante, Spain. Electronic address: sanchez_jos@gva.es.
authors.forename: J
authors.initials: J
authors.lastname: Sánchez-Payá
authors.affiliation: Department of Preventive Medicine, Alicante University General Hospital, Alicante, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Molina-Gómez
authors.affiliation: Department of Preventive Medicine, Alicante University General Hospital, Alicante, Spain.
authors.forename: P
authors.initials: P
authors.lastname: García-Shimizu
authors.affiliation: Department of Preventive Medicine, Alicante University General Hospital, Alicante, Spain.
authors.forename: V
authors.initials: V
authors.lastname: García Román
authors.affiliation: Department of Preventive Medicine, Alicante University General Hospital, Alicante, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Villanueva-Ruiz
authors.affiliation: Department of Preventive Medicine, Alicante University General Hospital, Alicante, Spain.
authors.forename: M
authors.initials: M
authors.lastname: González-Hernández
authors.affiliation: Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Alicante University, Alicante, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Nolasco-Bonmatí
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology*; D062665:Epidemiological Monitoring; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000453:epidemiology*; D062606:Tertiary Care Centers
keywords: Catheter-related bloodstream infection; Central venous catheter; Infection control; Primary bloodstream infection; Surveillance