Long-term impact of a program to prevent central-line associated bloodstream infection in a surgical intensive care unit

Background: Central-line associated bloodstream infection (CLABSI) is a very important  healthcare associated infection in intensive care units (ICU), with high mortality rates and also high healthcare costs.

Objective: To describe the long-term impact of a program for decreasing CLABSI rates in a surgical ICU in Sao Paulo, Brazil.

Methods: For this interrupted time series analysis, we compared CLABSI rates during an 18-month baseline period (from September 2005 to February 2007), an 18-month intervention period (from March 2007 to August 2008) and in an 18-month post-intervention period (from September 2008 to February 2010) in a cohort of patients who received central line catheterization in a 10-bed surgical ICU in Sao Paulo, Brazil. The studied intervention consisted of an 18-month program of weekly visits in the ICU by professionals belonging to infection control board, with inspection of all patients with central lines and guidance to ICU team on the correct techniques of insertion and maintenance of these catheters. Devices who did not present ideal conditions were requested to be removed. Bloodstream infection was defined according to Centers for Disease Control and Prevention criteria. CLABSI was considerated to be ICU related if detected at least 48 hours after admission to or less than 48 hours from discharge at the unit. CLABSI incidence density rates were expressed as total CLABSI episodes over the number of catheter-days. We used chi-square test to assess the impact of this program, comparing the intervention and post-intervention periods CLABSI incidence density rates with the incidence density of this infection on the baseline period.

Results: Baseline CLABSI average rate was 15,85 episodes over 1000 catheters-days. Intervention and post-intervention average rates were, respectively, 4,98 and 3,90 episodes over 1000 catheters-days. The studied program had a significantly impact in reducing the rates of CLABSI in this ICU when comparing both intervention and post-intervention periods (p<0,05 for both comparisons). Graphic 1 shows this decrease in CLABSI rates after the program.

Conclusions: Our program produced sustained CLABSI rate decreases in the long term. This success shows the importance of the interaction between infection control and ICU professionals in achieving the goal of reducing infections related to this setting.

Graphic  SEQ Figura \* ARABIC 1 - CLABSI average incidence density rates in baseline, intervention and post-intervention periods.