title: Bundle Approach to Reduce Bloodstream Infections in Neutropenic Hematologic Patients with a Long-Term Central Venous Catheter.
abstract: BACKGROUND
  The objective of the study was to reduce, by a bundle of interventions, the global bloodstream infections and catheter-related bloodstream infections rates in neutropenic hematology patients with a long-term central venous catheter.
  
  
  METHODS
  This was a non-randomized prospective study. It was conducted in a 20-bed hematology oncology unit (Portuguese Institute of Oncology, Porto, Portugal) between 1st of August 2010 and 31st of January 2012. In this period we introduced a bundle of interventions (study group) and compared the results with the six months prior to implementation (control group). The interventions consisted in the use of a neutral pressure mechanical valve connector instead of a positive pressure mechanical valve connector, a more frequent change of this connector and a more efficient clean solution. One hundred and sixteen hematology patients with a long-term central venous catheter at time superior of 72 h, with 8 867 central venous catheter days [6 756 central venous catheter days in the study group and 2 111 central venous catheter days in the control group] were included in the study.
  
  
  RESULTS
  A significant reduction in bloodstream infections rates and catheter-related bloodstream infections rates was achieved. Bloodstream infections rates: [32.69 (control group) vs. 9.43 (study group)], incidence reduction 71% [relative risk 0.2886, CI 95% (0.1793 - 0.4647), p < 0.001] and catheter-related bloodstream infections rates: [17.53 (control group) vs. 4.73 (study group)], incidence reduction 71% [relative risk 0.2936, CI 95% (0.1793 - 0.5615), p < 0.014]. No significant difference (p > 0.05) was found in the neutrophil count at the time of blood culture samples between groups: 69% (< 500 neutrophils/mm3) [71% (study group) vs. 68% (control group)].
  
  
  CONCLUSIONS
  The introduction of this bundle of interventions based on the variables of patient, product and practice, supported by the Healthcare and Technology Synergy framework, quickly resulted in a significant reduction of bloodstream infections and catheter-related bloodstream infections rates.
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Martinez
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Leite
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Daniela
authors.initials: D
authors.lastname: França
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Capela
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Luísa
authors.initials: L
authors.lastname: Viterbo
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Natalina
authors.initials: N
authors.lastname: Varajão
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Ângelo
authors.initials: Â
authors.lastname: Martins
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Oliveira
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Nélson
authors.initials: N
authors.lastname: Domingues
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Ilídia
authors.initials: I
authors.lastname: Moreira
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Santo
authors.affiliation: Microbiology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Filipe
authors.initials: F
authors.lastname: Trigo
authors.affiliation: Hematology Oncology Unit. Instituto Português de Oncologia Francisco Gentil. Porto. Portugal.
authors.forename: Jose
authors.initials: J
authors.lastname: Mariz
mesh_terms: D016470:Bacteremia / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D006801:Humans; D009503:Neutropenia; D011174:Portugal; D011312:Pressure; D011446:Prospective Studies