Zero bloodstream infection in medical wards: Achievable?

Abstract

Background: Nosocomial bloodstream infection (BSI) was a significant problem at medical wards Hospital Sungai Buloh, majority of which were central-line associated BSI (CLABSI). Central venous catheter (CVC) care was suboptimal. Although CLABSI prevention program in ICU is proven to be effective, it is less well studied in non-ICU settings. Hence, we embarked a project to achieve zero BSI in three busy medical wards at Hospital Sungai Buloh, a tertiary hospital. Methods and materials: A multimodal CLABSI risk reduction strategy was employed, using the 4 ‘E’ approach (Engage, Educate, Execute, Evaluate). The medical wards’ matrons, sisters and infection control link nurse (ICLN) were engaged to “champion” the BSI reduction program. Education was given to doctors and nurses, focusing on three key behaviours, which were: (1) insert CVC only when indicated; (2) take care of CVC properly; (3) remove CVC as soon as not needed. In addition, education sessions with ICLN were held to ensure they could identify BSI cases correctly based on CDC definitions. Education posters and visual cues were placed at strategic locations. CVC care bundle form was implemented. Prospective surveillance, which consist of monitoring process measure (compliance to CVC care bundle) and outcome measure (BSI rate), was done. These results were then feedback to the stakeholders on monthly basis. The study was divided into pre-intervention (January–May 2019), intervention (June and July 2019), and post-intervention periods (August and September 2019). Results: During the pre-intervention period, the rates of nosocomial BSI and CLABSI were average to be 6.4 cases/month and 3.4 cases/month respectively. During intervention period, the average rates were 8 cases/month and 4.5 cases/month respectively. After intervention, both rates reduced significantly to average 1 case/month (87.5% reduction in nosocomial BSI, and 77.8% reduction in CLABSI). In fact, we achieved zero CLABSI in August 2019. This corresponded with improved CVC care compliance from average 46% during intervention period to 83% compliance rate post-intervention. Conclusion: Zero BSI, even in non-ICU settings, is achievable via multimodal strategy. Currently, we are continuing our program to ensure sustainability in reduction of BSI rates.