PURPOSE:Our ICU bloodstream infection (BSI) rates were hovering at the National Nosocomial Infection Surveillance (NNIS) 50th percentile (3–7.2) infections per 1,000 CVC days from January through June 2006; necessitating a performance improvement (PI) initiative designated to decrease the incidence of BSI.
METHODS:A central venous catheter (CVC) bundle that incorporates the Center for Disease Control (CDC) Guidelines for Prevention of BSI was instituted in July 2006. The central line bundle has five key components: 1. Hand hygiene 2. Maximal barrier precautions 3. Chlorhexidine skin antisepsis 4. Optimal catheter site selection, with subclavian vein as the preferred site for non-tunneled catheters 5. Daily review of line necessity, with prompt removal of unnecessary lines. In July 2006, an intervention that audited compliance with the CVC bundle and provided feedback to ICU staff was started in two different ICU’s (Medical ICU: MICU-C, and Surgical ICU: SSCU-B). BSI rates were followed using NNIS criteria.
RESULTS:CVC bundle compliance rates steadily increased to 85–95% in both medical and surgical ICUs. This correlated with a decrease in BSI rates from 3.8 to 2.1 per 1000 CVC days in the medical ICU, whereas BSI rate decreased to 0 in surgical ICU for the last 6 months.
CONCLUSION:Improved compliance with the five bundle elements is an effective way to decrease BSI secondary to CVCs in ICU setting. Zero rate of CVC infections was achieved for six consecutive months in the surgical ICU.
CLINICAL IMPLICATIONS:Prevention of BSI requires concerted efforts on the part of hospital administration, physicians, and ICU personnel. The program must be evidence-based, maintained, and accepted by ICU personnel. Continued education and feedback are crucial to maintain a low BSI rate.
DISCLOSURE:Nabil Abouchala, None.