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Catheter-related bloodstream infection: burden of disease in a tertiary hospital
H R Martínez-Morel1, J Sánchez-Payá2, M J Molina-Gómez2
1Department of Preventive Medicine, Alicante University General Hospital, Alicante, Spain; Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Alicante University, Alicante, Spain.
Insights
A hospital-wide catheter-related bloodstream infection (CRBSI) program reduced infection rates. This study highlights the importance of surveillance, observation, and education for effective CRBSI control across all settings.
Area of Science:
- Infection Control
- Hospital Epidemiology
- Public Health
Background:
- Catheter-related bloodstream infections (CRBSI) pose a significant threat in healthcare settings.
- Effective surveillance programs are crucial for controlling CRBSI, yet comprehensive hospital-wide strategies are understudied.
Purpose of the Study:
- To evaluate a CRBSI control and prevention program implemented across all hospital settings.
- To assess the program's impact on the burden of disease and compliance with best practices for catheter insertion and maintenance.
Main Methods:
- Implementation of a multi-faceted CRBSI control program including surveillance, direct observation of procedures, and staff education.
- Monitoring of short-term and long-term catheter utilization and associated infection rates.
- Assessment of healthcare worker compliance with recommended insertion and maintenance protocols.
Main Results:
- The program demonstrated a reduction in CRBSI incidence density for both short-term (5.98/1000 catheter-days) and long-term (0.57/1000 catheter-days) catheters.
- Observed compliance varied, with high rates for hand hygiene during insertion (86.8%) but lower rates for skin disinfection (35.5%) and port disinfection during maintenance (32.5%).
- Significant disparities in compliance were noted between insertion and maintenance procedures.
Conclusions:
- The implemented CRBSI control and prevention program effectively decreased infection rates.
- The study provides valuable data on the burden of CRBSI and identifies specific areas for intervention improvement, particularly in maintenance protocols.
- A comprehensive, hospital-wide approach is essential for successful CRBSI management.
Background:
Surveillance programmes have become the most effective tool for controlling catheter-related bloodstream infections (CRBSI). However, few studies have investigated programmes covering all hospital settings.
Aim:
To describe the results of a control and prevention programme for CRBSI based on compliance with recommendations for insertion and maintenance, using annual burden of disease in a tertiary level hospital.
Methods:
A CRBSI control and prevention programme involving all hospital settings was implemented. The programme consisted of CRBSI surveillance, direct observation of insertion and maintenance of catheters to determine performance, and education for healthcare workers.
Findings:
In total, 2043 short-term catheters were inserted in 1546 patients for 18,570 catheter-days, and 279 long-term catheters were inserted in 243 patients for 40,440 catheter-days. The annual incidence density was 5.98 (first semester 6.40, second semester 5.64) CRBSI per 1000 catheter-days for short-term catheters, and 0.57 (first semester 0.66, second semester 0.43) CRBSI per 1000 catheter-days for long-term catheters. One hundred and forty insertion procedures were observed, with an average insertion time of 13 (standard deviation 7) min. Compliance with recommendations was as follows: hand hygiene, 86.8%; use of alcoholic chlorhexidine solution for skin disinfection, 35.5%; use of mask, 93.4%; use of gloves, 98.7%; use of gown, 75.0%; use of sterile cloth, 93.8%; use of cap, 92.2%; bandage application, 62.7%; and use of aseptic technique, 89.5%. Forty-five maintenance procedures were observed, and compliance rates were as follows: hand hygiene, 42.1%; use of gloves, 78.1%; and port disinfection with alcoholic chlorhexidine solution, 32.5%.
Conclusion:
The CRBSI control and prevention programme implemented at the study hospital has decreased the rate of CRBSI, provided important information about the total burden of disease, and revealed possible ways to improve interventions in the future.
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