Abstract
BackgroundOutside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted “bundle” approach in controlling CVC-ABSIs outside ICU.MethodsFrom 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases.ResultsPrevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in last three years, showing a 63.1% decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95%CI: 0.04-0.91).ConclusionThe rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.
Highlights
Outside intensive care units (ICUs), Central Venous Catheters (CVC)-ABSIs epidemiology and the results of strategies for their prevention are not well known
The use of CVC was associated with underlying rapidly fatal illness compared to and non fatal illness and with higher mean age of patients (72.3 ± 15.3 vs 59.3± 19.8 years, p
Prevalence of surgical operation, prevalence of CVC use and parenteral nutrition utilisation were not modified over time
Summary
Outside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. In 2002 alone, an estimated 250,000 health care–onset catheter-associated bloodstream infections occurred in the United States, resulting in 30,000 deaths. A complete description of prevention practices is available [2] and the results from several collaborative studies have demonstrated a roughly 70% reduction in catheterassociated bloodstream infection rates in intensive care units (ICUs) by increasing adherence to recommended best practices for the insertion of Central Venous Catheters (CVC) [3]. Most prevention efforts have focused on ICUs basically due to better nurse and physician to patient staffing ratios and the higher risk populations. The validity of these results outside of ICUs is not well known. Types and use of vascular catheters, site and duration of catheterization, average patient stay, amount of antibiotic treatment given, and after care, appear to vary between ICUs and general wards, as well as unjustified use and inadequate dressing of catheters that might be more common outside ICUs [5]
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