The long-term effect of bundle care for catheter-related blood stream infection: 5-year follow-up

Area of Science:

• Infection Control
• Critical Care Medicine
• Public Health

Background:

• Catheter-related bloodstream infections (CRBSI) pose a significant risk in intensive care settings.
• Long-term data is crucial for evaluating the sustained impact of infection control strategies.
• Cardiovascular intensive care units (CVICs) have a high prevalence of catheter use.

Purpose of the Study:

• To evaluate the effectiveness of a comprehensive bundle care protocol in reducing CRBSI.
• To assess the long-term impact and persistence of CRBSI reduction strategies.
• To analyze the correlation between CRBSI reduction and overall bloodstream infection (BSI) rates.

Main Methods:

• A prospective longitudinal cohort study was conducted over five years (January 2010 - June 2015) in a CVICU.
• A multidisciplinary team implemented standardized CRBSI bundle care for approximately 1400 critically ill patients annually.
• Key outcome measures included CRBSI rates per 1000 catheter days, BSI per 1000 inpatient days, and catheter utilization rates.

Main Results:

• The CRBSI rate decreased significantly from 7.0 to 0.7 per 1000 catheter days (p<0.001).
• A cubic polynomial function best described the stepwise and persistent decline in CRBSI rates (R²=0.501, p=0.005).
• Overall BSIs also significantly decreased (4.4 to 0.5 per 1000 inpatient days, p<0.001) and strongly correlated with CRBSI reduction (r=0.86, p<0.001).

Conclusions:

• Bundle care is a highly effective strategy for significantly reducing CRBSI in CVICUs.
• The positive effects of bundle care are stepwise, persistent, and sustainable with ongoing commitment.
• Successful CRBSI reduction contributes to a broader decrease in overall bloodstream infections.