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Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: In 2006 Pronovost reported implementation of a central venous catheter insertion bundle was associated with a reduction in central line-associated bloodstream infections (CLABSI) below those reported by NHSN. At Denver VAMC the CLABSI incidence density remained high despite compliance with the line insertion bundle. Each CLABSI was reviewed and noted trends were the basis for a plan to reduce the incidence density of CLABSIs.
Objective: To study the impact of a central line site care program on CLABSI.
Methods: Data on CLABSIs was collected by Infection Preventionists using standard Centers for Disease Control and Prevention (CDC) definitions for identifying infections and reporting central line days.
April 1, 2007-Sep 30, 2007 was defined as a run-in period during which data collection was not reliable, excluding it from analysis. The baseline period was Oct 1 2007-Sep 30 2008. The intervention period with full implementation of the line care bundle was Oct 1, 2008 through Sep 30, 2009. On October 1, 2008, the program was extended to non-ICU wards.
Elements of the line care bundle include: daily inspection of the site and documentation of ongoing need, correct application of a CHG-impregnated sponge to the insertion site, and a 15 second alcohol scrub to the infusion hub prior to each use. Additional education was developed at a hospital-wide level, to ensure nursing staff were trained in proper care.
Statistical analyses were performed using Prizm InStat, including relative risk for infection at a 95% confidence interval. Incidence density was compared using chi square.
Results: Reported compliance with the insertion bundle was 94% during the baseline period and 93% during the intervention period. In 2007-2008 there were 4415 catheter days and 24 CLABSIs, resulting in an incidence density of 5.4 /1000 catheter days. From Oct 1, 2008-Sep 30, 2009 there were 2825 central venous catheter and 3 CLABSIs, for an incidence density of 1.06/1000 catheter days. The relative risk for a CLABSI in the ICUs after implementation of the line care bundle was 0.28 (0.10-0.83, P=0.006). Non-ICU data: Between Oct 1, 2008 and Sep 30, 2009 there were 4049 catheter days in non-icu acute care nursing units, and 9 primary bloodstream infections, resulting in a CLABSI incidence density of 2.2/1000 catheter days. The relative risk of CLABSI in ICU versus ward was 0.61 (0.23-1.62, P=0.4).
Objective: To study the impact of a central line site care program on CLABSI.
Methods: Data on CLABSIs was collected by Infection Preventionists using standard Centers for Disease Control and Prevention (CDC) definitions for identifying infections and reporting central line days.
April 1, 2007-Sep 30, 2007 was defined as a run-in period during which data collection was not reliable, excluding it from analysis. The baseline period was Oct 1 2007-Sep 30 2008. The intervention period with full implementation of the line care bundle was Oct 1, 2008 through Sep 30, 2009. On October 1, 2008, the program was extended to non-ICU wards.
Elements of the line care bundle include: daily inspection of the site and documentation of ongoing need, correct application of a CHG-impregnated sponge to the insertion site, and a 15 second alcohol scrub to the infusion hub prior to each use. Additional education was developed at a hospital-wide level, to ensure nursing staff were trained in proper care.
Statistical analyses were performed using Prizm InStat, including relative risk for infection at a 95% confidence interval. Incidence density was compared using chi square.
Results: Reported compliance with the insertion bundle was 94% during the baseline period and 93% during the intervention period. In 2007-2008 there were 4415 catheter days and 24 CLABSIs, resulting in an incidence density of 5.4 /1000 catheter days. From Oct 1, 2008-Sep 30, 2009 there were 2825 central venous catheter and 3 CLABSIs, for an incidence density of 1.06/1000 catheter days. The relative risk for a CLABSI in the ICUs after implementation of the line care bundle was 0.28 (0.10-0.83, P=0.006). Non-ICU data: Between Oct 1, 2008 and Sep 30, 2009 there were 4049 catheter days in non-icu acute care nursing units, and 9 primary bloodstream infections, resulting in a CLABSI incidence density of 2.2/1000 catheter days. The relative risk of CLABSI in ICU versus ward was 0.61 (0.23-1.62, P=0.4).
Conclusions: Attention to sterile technique at the time of insertion of a central venous catheter is necessary but not sufficient to preventing infections.
Following sterile insertion, ongoing attention to minimizing microbial load at every access point to the system was associated with a reduction in CLABSI.
The incidence density of CLABSI is similar on ward units and intensive care units.
Surveillance of CLABSI on all nursing units is feasible with existing resources.