Abstract
Reducing the Incidence of CLABSI in Latin American ICUs: A Multi-Country Quality Improvement Collaborative Project. Preliminary Results from the Second Phase
Jafet Arrieta Torres, MD, MMSc, IA1, Pedro Delgado, MSc2, Carolina Giuffre, BSN, ICN3, Carola Orrego4, Viviana Rodriguez, MD5, Dolores Macchiavello, MD5, Nuria Mora6, Marcela Colmenares, MD7 and Ezequiel Garcia Elorrio, MD, MSc, MBA, PhD5
(1)Harvard T.H. Chan School of Public Health, Boston, MA, (2)Institute for Healthcare Improvement, Cambridge, MA, (3)Hospital Britanico, Buenos Aires, Argentina, (4)Avedis Donabedian Research / Institute University Autonomous of Barcelona, Barcelona, Spain, (5)Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina, (6)Avedis Donabedian Research Institute / University Autonomous of Barcelona, Barcelona, Spain, (7)Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background
Central line-associated bloodstream infections (CLABSI) are the leading cause of healthcare-associated bloodstream infections, prolonging hospitalizations, and increasing healthcare costs, morbidity and mortality. The CLABSI rate has been estimated at 7.6 episodes per 1,000 central line days in Latin America. In developing countries, CLABSI are usually the result of failing to follow evidence-based, standardized health practices.
Objective
The second phase of the 'Goodbye Bacteremia' campaign aimed at reducing the CLABSI rate in Latin American Intensive Care Units (ICUs) by 50% or to less than 2 episodes per 1,000 central line days from self-reported baseline within 12 months of the implementation of the campaign.
Methods
Design: Uncontrolled before-and-after CLABSI rates comparison.
Setting: 95 ICUs from 37 hospitals from six Latin American countries.
Intervention: We used a quality-improvement collaborative to promote the adoption of bundles of care for the insertion and maintenance of central lines, coupled with education through virtual bi-weekly learning sessions, and continuous feedback, from June 2014 to June 2015.
Measures: CLABSI rate; percentage compliance with central line insertion bundle; percentage compliance with central line maintenance bundle.
Results
A total of 382 episodes of CLABSI occurred over 197,185 central line days (incidence rate [IR], 1.94) during the implementation of the campaign, compared to 127 episodes per 49,116 central lines days (IR, 2.59) at baseline. The overall reduction on the CLABSI rate was 26% (IR ratio, 0.75; 95% CI 0.61, 0.92). The median CLABSI rate was zero throughout the campaign for the participating ICUs. The average percentage compliance increased 23.24% from a baseline of 65.55% to 85.4% for the insertion bundle, and 15.05% from 80.71% at the beginning to 95.0% at the end of the campaign for the maintenance bundle.
Conclusions
Evidence-based interventions and multi-country collaborative work contributed to a significant reduction in the incidence of CLABSI in Latin American ICUs.
Public health or related organizational policy, standards, or other guidelines