Abstract
BackgroundCentral line-associated bloodstream infections (CLABSIs) can be prevented through well-coordinated, multifaceted programs. However, implementation of CLABSI prevention programs requires individualized strategies for different institutional situations, and the best strategy in resource-limited settings is uncertain. Peer tutoring may be an efficient and effective method that is applicable in such settings.MethodsA prospective intervention was performed to reduce CLABSIs in a surgical intensive care unit (SICU) at a tertiary hospital. The core interventions consisted of implementation of insertion and maintenance bundles for CLABSI prevention. The overall interventions were guided and coordinated by active educational programs using peer tutoring. The CLABSI rates were compared for 9 months pre-intervention, 6 months during the intervention and 9 months post-intervention. The CLABSI rate was further observed for three years after the intervention.ResultsThe rate of CLABSIs per 1000 catheter-days decreased from 6.9 infections in the pre-intervention period to 2.4 and 1.8 in the intervention (6 m; P = 0.102) and post-intervention (9 m; P = 0.036) periods, respectively. A regression model showed a significantly decreasing trend in the infection rate from the pre-intervention period (P < 0.001), with incidence-rate ratios of 0.348 (95% confidence interval [CI], 0.98–1.23) in the intervention period and 0.257 (95% CI, 0.07–0.91) in the post-intervention period. However, after the 9-month post-intervention period, the yearly CLABSI rates reverted to 3.0–5.4 infections per 1000 catheter-days over 3 years.ConclusionsImplementation of CLABSI prevention bundles using peer tutoring in a resource-limited setting was useful and effectively reduced CLABSIs. However, maintaining the reduced CLABSI rate will require further strategies.
Highlights
Central line-associated bloodstream infections (CLABSIs) can be prevented through well-coordinated, multifaceted programs
The rate of CLABSIs per 1000 catheter-days decreased from 6.9 infections in the pre-intervention period to 2.4 and 1.8 in the intervention (6 m; P = 0.102) and postintervention (9 m; P = 0.036) periods, respectively (Table 1 and Fig. 2)
The regression model showed a significantly decreasing trend in the infection rate from the preintervention period (P < 0.001) with incidence-rate ratios of 0.348 (95% confidence interval [Confidence intervals (CIs)], 0.98–1.23) in the intervention period and 0.257 in the post-intervention period
Summary
Central line-associated bloodstream infections (CLABSIs) can be prevented through well-coordinated, multifaceted programs. Implementation of CLABSI prevention programs requires individualized strategies for different institutional situations, and the best strategy in resource-limited settings is uncertain. Central line-associated bloodstream infection (CLABSI) is one of serious healthcare-associated infections that cause increased medical costs, morbidity and mortality; CLABSIs have been prevented in many developed and developing countries using multifaceted approaches [1,2,3,4,5]. The importance of infection control in healthcare settings for patient safety and quality of care cannot be emphasized enough, but the available resources including expert personnel, reimbursement systems and. Different strategies for different regional or institutional situations are needed for the successful implementation of CLABSI prevention guidelines
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