Improvement cycle to act against catheter-related bloodstream infections

Abstract

Abstract Background Catheter-related bloodstream infections (CRBSI) pose significant risks, causing a prolongation of hospital stay, increasing costs and increasing the risk of complications and mortality. It is the first healthcare-associated infection in many hospitals including our institution. Preventing CRBSI is essential for safety in patient’s care. To achieve this, we’ve adopted improvement cycles as a tool, aiming to decrease CRBSI rates by 50%. Methods Over the period of 2012 to 2023, 9036 pediatric patients were monitored throughout their hospitalizations. We utilized improvement cycles through various interventions: first an intervention bundle, secondly avoiding multipuncture, thirdly improving sampling techniques, fourthly optimizing supply management, and lastly restructuring the vascular access clinic. Each cycle involved resource management and process enhancement. Progress was measured through percentage metrics and the primary outcome indicator was CRBSI rates. Results The first cycle achieved a 90% compliance, the achievements were compliance above 85% of the bundle. In the second cycle we attained an 85% compliance, implement a guideline for catheter insertion with only two punctures in practice. The third cycle saw a 70% compliance rate, involving a multidisciplinary team for taking samples, training and monitoring by a skilled supervisor. The fourth cycle reached a 60% compliance through a techno-vigilance process, it was a pity quickly practical solutions didn´t work in practice. The final cycle achieved a 70% compliance, establishing a functional vascular access clinic. Rates CRBSI decreased by 50% overall and in the pediatric intensive care unit, meeting our objective. However this reduction was not observed in other intensive care units. Conclusion Improvement cycles simplify changes. Their implementation is effective but requires close monitoring, support from resources and authorities, a committed and proactive team, and continuous changes according to results. There is a need to consolidate the strategies to sustain and enhance our achievements.