Background
“Zero” central line-associated bloodstream infections (CLABSI) have not been reported
from Asian countries, which usually have predominance of difficult to curtail gram
negative infections. It also remains unclear whether lowering CLABSI rates below National
Healthcare Safety Network (NHSN) benchmarks in such countries is even possible. In
this study, we evaluated effects of a quality improvement initiative to achieve “Zero
CLABSI” in our intensive care unit.
Methods
A root cause analysis in February 2010 identified problems with clinical practice,
environment, and products. Extensive education sessions were followed by implementation
of strategies in the form of “itemized” bundles derived from practice guidelines,
with complete enforcement starting August 2010. Results were benchmarked against NHSN
data. Data were analyzed in a preintervention (1 year) and postintervention (2 years)
fashion, using Poisson regression analysis to generate incidence-rate ratio (IRR).
Results
In the preintervention period, CLABSI rate was 6.9/1,000 catheter-days (CDs) (35 CLABSI/5,083
CDs). In the postintervention year 1, rate was 1.06/1,000 CDs (4 CLABSI/3,787 CDs)
with IRR of 0.15 (95% confidence interval: 0.04-0.44, P < .001) and reduction of 85%. In postintervention year 2, rate was 0.35/1,000 CDs
(1/2,860 CDs) with IRR of 0.05 (95% confidence interval: 0.001-0.31, P < .001). There was a period of “Zero CLABSI” for 15 consecutive months, surpassing
NHSN benchmarks.
Conclusion
: CLABSIs can be eliminated in any intensive care unit regardless of the location
and type of organism. NHSN data should be a realistic CLABSI benchmarking target for
developing countries.
Key Words
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Article info
Publication history
Published online: September 16, 2013
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
