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Published on: July 13, 2019
The effect of an intervention bundle to prevent central venous catheter-related bloodstream infection in a national
T I I van der Kooi1, E A Smid2, M B G Koek1
1National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands.
Insights
A national central line-associated bloodstream infection (CLABSI) bundle reduced CLABSI incidence. Outside intensive care units (ICUs), adherence to the insertion bundle significantly lowered CLABSI risk.
Area of Science:
- Infection Prevention and Control
- Healthcare Epidemiology
- Patient Safety
Background:
- Central venous catheters (CVCs) are a common source of central line-related bloodstream infections (CRBSIs).
- A national six-item intervention bundle was implemented in Dutch hospitals in 2009 to mitigate CRBSI rates.
Purpose of the Study:
- To evaluate the effectiveness of a national intervention bundle on reducing CRBSI risk.
- To assess the impact of bundle compliance on CRBSI incidence in various hospital settings.
Main Methods:
- Analysis of national CRBSI surveillance data from 2009-2019 across 66 hospitals.
- Bundle compliance assessed for overall (6-item), insertion (4-item), and maintenance (2-item) bundles.
- Multi-level Cox regression models used to estimate the impact of bundle compliance on CRBSI risk.
Main Results:
- CRBSI incidence decreased from 4.0 to 1.6 per 1000 CVC days in 56 participating hospitals.
- In intensive care units (ICUs), no significant association was found between bundle compliance and CRBSI risk.
- Outside ICUs, improved compliance with the insertion bundle was associated with a decreased CRBSI risk (HR 0.50), while maintenance bundle compliance showed increased risk (HR 1.68).
Conclusions:
- A national program introducing an intervention bundle led to a significant reduction in CRBSI incidence.
- Bundle compliance did not correlate with CRBSI risk in ICUs.
- Outside ICUs, enhanced adherence to the insertion bundle component of the intervention significantly reduced CRBSI risk.
Introduction:
Central venous catheters (CVCs) can lead to central line-related bloodstream infections (CRBSIs). A six-item bundle was introduced in 2009 to prevent CRBSI in Dutch hospitals.
Aim:
This study aimed to determine the impact of an intervention bundle on CRBSI risk.
Methods:
Data were obtained from hospitals participating in the national CRBSI surveillance between 2009 and 2019. Bundle compliance was evaluated as a total ('overall') bundle (all six items) and as an insertion bundle (four items) and a maintenance bundle (two daily checks). We estimated the impact of the overall and partial bundles, using multi-level Cox regression.
Findings:
Of the 66 hospitals in the CRBSI surveillance 56 (84.8%) recorded annual bundle (non)compliance for >80% of the CVCs, for one to nine years. In these 56 hospitals CRBSI incidence decreased from 4.0 to 1.6/1000 CVC days. In the intensive care units (ICUs), compliance was not associated with CRBSI risk (hazard ratio (HR) for the overall, insertion and maintenance bundle were 1.14 (95% confidence interval 0.80-1.64), 1.05 (0.56-1.95) and 1.13 (0.79-1.62)), respectively. Outside the ICU the non-significant association of compliance with the overall bundle (HR 1.36 (0.96-1.93)) resulted from opposite effects of the insertion bundle, associated with decreased risk (HR 0.50 (0.30-0.85)) and the maintenance bundle, associated with increased risk (HR 1.68 (1.19-2.36)).
Conclusion:
Following a national programme to introduce an intervention bundle, CRBSI incidence decreased significantly. In the ICU, bundle compliance was not associated with CRBSI risk, but outside the ICU improved compliance with the insertion bundle resulted in a decreased CRBSI risk.
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