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Impact of Targeted Interventions on Trends in Central Line-Associated Bloodstream Infection: A Single-Center
Sun Young Cho1, Doo Ryeon Chung, Jae Geum Ryu
11Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea. 3Department of Biostatistics, Samsung Biomedical Research Institute, Seoul, Republic of Korea.
Objective:
To assess the impact of targeted interventions on trends in central line-associated bloodstream infection.
Design:
A before-and-after study between January 2013 and September 2014.
Setting:
Tertiary hospital in the Republic of Korea.
Patients:
All patients with central-line catheters in the hospital.
Interventions:
In September 2013, interventions that targeted central line insertion practices were implemented in 10 ICUs, including compliance monitoring with a central line insertion practices bundle and use of an all-inclusive catheter kit. The impact of targeted interventions on trends in central line-associated bloodstream infection was evaluated by segmented autoregression analysis of an interrupted time series.
Measurements And Main Results:
The average hospital-wide central line-associated bloodstream infection rates in the baseline and intervention periods were 1.84 and 1.56 per 1,000 catheter-days, respectively. During the baseline period, there was an increase of central line-associated bloodstream infection rate of 0.12 per 1,000 catheter-days per month. In the intervention period, there was a decrease of central line-associated bloodstream infection rate of 0.16 per 1,000 catheter-days per month (change in slope, -0.28; 95% CI, -0.37 to -0.19; p < 0.0001). In ICUs, the average central line-associated bloodstream infection rates in the baseline and intervention periods were 1.92 and 1.64 per 1,000 catheter-days, respectively. During the baseline period, there was an increase of central line-associated bloodstream infection rate of 0.18 per 1,000 catheter-days per month in ICUs. After sequential-targeted interventions, there was a decrease of central line-associated bloodstream infection rate of 0.16 per 1,000 catheter-days per month (change in slope, -0.34; 95% CI, -0.50 to -0.18; p = 0.0007).
Conclusions:
Targeted interventions were associated with significant changes in trends in the occurrence rate of central line-associated bloodstream infection in ICUs and the entire hospital.
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