Impact of an Multimodal Strategy to Reduce Central Line-associated Bloodstream Infections in a Medical-Surgical ICU in Colombia

Background: Central Line-Associated Bloodstream Infections (CLABSI)  are related to  prolongation of hospital stay and increased cost and risk of mortality

Objective: The purpose of this study was to determine the impact of an multimodal strategy (surveillance, educational clinical and administrative components) to decrease CLABSI in a medical-Surgical  intensive care unit

Methods: A quasiexperimental study involving multiple interventions to reduce the incidence of CLABSI was conducted from 2003 to 2009.  From  2003 to May 2005 (phase 1), was implemented  outcome and process surveillance. Additionally  In april 2005 was implemented an strategy based to hand hygiene education, preventive isolation policy, protocol to insertion of catheter, checklist to prevent CLABSI and improvement in the provision of supplies for infection control. From June 2005 to December 2009 (phase 2), we intervened in these processes at the same time that surveillance was maintained.Rates of CLABSI in Phases 1 and 2 were compared using Odds ratio (OR) ratios with 95% confidence intervals (CIs).

Results: A total of 11568 patients were included. Patient demographic and clinical characteristics were similar in the 2 phases. The mean incidence density of CLABSI per 1000 catheter-days in the ICU was 6.1 in the first year of phase 1 and 1.5 in the last year of phase 2. OR, 0.43 (95%CI 0.24-0.80; p: 0.009). Figure 1

Conclusions: These results suggest that reducing CLABSI rates in an ICU setting not only is possible this but also maintain over time a low rate in countries with limited resources.