title: Central line-associated bloodstream infection in a trauma intensive care unit: impact of implementation of Society for Healthcare Epidemiology of America/Infectious Diseases Society of America practice guidelines.
abstract: BACKGROUND
  This study aimed to assess the impact implementation of the basic Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) practice recommendations in reducing central line-associated bloodstream infection (CLABSI) in intensive care units (ICUs).
  
  
  METHODS
  The prospective study was conducted from January 2011-December 2012 at the 23-bed trauma ICU in Saudi Arabia. The basic SHEA/IDSA practice recommendations were introduced and implemented during the year 2012. Laboratory-confirmed CLABSIs were identified, and the antimicrobial susceptibility of isolates was determined. Data were collected and analyzed for benchmarking with the National Healthcare Safety Network.
  
  
  RESULTS
  There was a 58% decline in the CLABSI incidence rate from 3.87 to 1.5 per 1,000 central line days in 2011 and 2012, respectively (standardized infection ratio, 0.42; P = .043). Three institutional risk factors were identified and resolved: health care personnel education, removal of nonessential catheters, and use of a catheter cart. Three Klebsiella pneumoniae isolates susceptible only to imipenem, 1 pandrug resistant Acinetobacter baumannii, and 2 Enterococcus faecalis, with 1 isolate resistant to vancomycin, were identified in 2012.
  
  
  CONCLUSIONS
  The basic SHEA/ISDA practice recommendation is an effective prevention model for the reduction of CLABSIs in the ICU. Additional measures are needed to control the spread of multidrug-resistant organisms.
authors.affiliation: Infection Prevention and Control Department, King Abdul Aziz Specialists Hospital, Taif, Saudi Arabia. Electronic address: waleed.mazi@ki.se.
authors.forename: Waleed
authors.initials: W
authors.lastname: Mazi
authors.affiliation: Infection Prevention and Control Department, King Abdul Aziz Specialists Hospital, Taif, Saudi Arabia.
authors.forename: Zikra
authors.initials: Z
authors.lastname: Begum
authors.affiliation: Infection Prevention and Control Department, King Abdul Aziz Specialists Hospital, Taif, Saudi Arabia.
authors.forename: Diaa
authors.initials: D
authors.lastname: Abdulla
authors.affiliation: Intensive Care Unit, King Abdul Aziz Specialists Hospital, Taif, Saudi Arabia.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hesham
authors.affiliation: Intensive Care Unit, King Abdul Aziz Specialists Hospital, Taif, Saudi Arabia.
authors.forename: Sami
authors.initials: S
authors.lastname: Maghari
authors.affiliation: Preventive Medicine, Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Assiri
authors.affiliation: Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Abiola
authors.initials: A
authors.lastname: Senok
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000517:prevention & control; D040981:Acinetobacter baumannii / Q000302:isolation & purification; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D013293:Enterococcus faecalis / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000453:epidemiology / Q000517:prevention & control; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D012529:Saudi Arabia; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications*
keywords: Central line–associated bloodstream infection; National Healthcare Safety Network benchmarking; Society for Healthcare Epidemiology of America/Infectious Diseases Society of America practice guidelines