Impact of bundle for central line associated bloodstream infections prevention

Abstract

Introduction objectives: Bundles have been developed to facilitate the application of infection control guidelines. Because in our institution the rates of central line associated bloodstream infections (CL-BSI) were above the international standards it was decided to implement a specific bundle through a multimodal approach. The aim of this study was to describe the strategy of bundle implementation for prevention of CL-BSI and to estimate their impact. Methods: Since Mar'10 the following measures were implemented at the ICUs to prevent CL-BSI: use central venous catheters only if strictly necessary; avoiding the femoral site if possible; hand hygiene with alcohol-gel before insertion; using full-barrier precautions during the insertion of central venous catheters; cleaning the skin with chlorhexidine (2%) and removing unnecessary catheters. The implementation was carried out through the model of "5Es" (Engage, Education, Execution, Evaluation and Encouragement). The rate of CL-BSI during the intervention period (Mar'10-Feb'11) was compared with the average of the 12 months prior to implementation. All costs are expressed in US dollars. For economic impact analysis an attributable cost of US 5,500 was used. Results: The incidence rate of CL-BSI at the baseline period was 6.84 events per device-days in comparison with 2.70 events per devicedays during implementation period (RR 0.40; 95% CI 0.22 to 0.69, p<0,01). There are no changes in the utilization ratio between both periods (0.45 6429/14222 and 0.44 7025/16077, respectively). During the implementation period the level of adherence rises to more than 90% in all bundle components. While the annual incremental cost to prevent CLBSI was US 28,300, the overall net savings was US 130,500. Conclusion: The effective implementation of this bundle in our hospital reduced the CL-BSI with a significant net saving.