title: Reducing Staphylococcus aureus bloodstream infections associated with peripheral intravenous cannulae: successful implementation of a care bundle at a large Australian health service.
abstract: BACKGROUND
  Healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB) results in morbidity, mortality, and increased healthcare costs, and these infections are frequently regarded as preventable.
  
  
  OBJECTIVE
  To implement a multi-modal prevention programme for improved processes regarding peripheral intravenous cannula (PIVC) insertion and maintenance, in order to reduce PIVC-associated HA-SAB events in a large Australian health service.
  
  
  METHODS
  Baseline clinical practice was evaluated for a 12-month pre-intervention period. Measures to reduce HA-SAB risk were introduced between January and September 2013: staff education, improved documentation (including phlebitis scoring), and availability of standardized equipment. Post-intervention auditing was performed during the 27 months following intervention. Baseline and post-intervention HA-SAB and PIVC-associated infection rates were compared. Interrupted time-series and Bayesian change-point analyses were applied to determine the impact of interventions and timing of change.
  
  
  RESULTS
  Significantly improved documentation regarding PIVC insertion and management was observed in the post-intervention period, with fewer PIVCs left in situ for ≥4 days (2.6 vs 6.9%, P<0.05). During the baseline period a total of 68 HA-SAB events occurred [1.01/10,000 occupied bed-days (OBDs)] and 24 were PIVC-associated (35% of total, rate 0.39 per 10,000 OBDs). In the post-intervention period, a total of 83 HA-SAB events occurred (0.99 per 10,000 OBDs) and 12 were PIVC-associated (14.4% of total, rate 0.14 per 10,000 OBDs). PIVC-associated SAB rates were 63% lower in the post-intervention period compared to baseline (P=0.018) with a change point observed following full bundle implementation in October 2013.
  
  
  CONCLUSIONS
  A successful multi-modal hospital-wide campaign was introduced to reduce PIVC-associated SAB rates. Evaluation of cost-effectiveness and sustainability is required.
authors.affiliation: Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Rhodes
authors.affiliation: Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: A C
authors.initials: AC
authors.lastname: Cheng
authors.affiliation: Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia.
authors.forename: S
authors.initials: S
authors.lastname: McLellan
authors.affiliation: Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Guerra
authors.affiliation: Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Karanfilovska
authors.affiliation: Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Aitchison
authors.affiliation: Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Watson
authors.affiliation: Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Bass
authors.affiliation: Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia. Electronic address: l.worth@alfred.org.au.
authors.forename: L J
authors.initials: LJ
authors.lastname: Worth
mesh_terms: D001315:Australia; D000072601:Cannula / Q000009:adverse effects*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D006296:Health Services; D006302:Health Services Research; D006801:Humans; D017053:Infection Control / Q000379:methods*; D064872:Patient Care Bundles / Q000379:methods*; D018805:Sepsis / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification*
keywords: Care bundle; Healthcare-associated; Peripheral venous cannulation; Staphylococcus aureus bacteraemia