547. Effectiveness of Catheter-Associated Bloodstream Infection Bundle Without and With Intensified Hand Hygiene Promotion in A Thai Tertiary Care Center: A 3-Year Study
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: We sought to determine the impact of a hospital-wide intensified hand hygiene promotion on the rates of catheter-associated bloodstream infections (CA-BSI).
Setting: A 500-bed, Thai tertiary care center.
Methods: A 3-year, prospective, quasi-experimental study was conducted for 1-year before the intervention (period 1), 1-year after the implementation of CA-BSI bundle without intensified hand hygiene promotion (period 2), and 1-year after the implementation of CA-BSI bundle with intensified hand hygiene promotion (period 3).
Results: Compared to period 1 (8% adherence), the “5 moments” hand hygiene adherence was improved during period 2 (24%; P<0.001) and period 3 (54%; P<0.001). Before the intervention, there were 88 episodes of CA-BSI (14 cases per 1000 catheter-days). During period 2, CA-BSI rates decreased by 54.1 % (6.4 cases per 1000 catheter-days; P<0.001). CA-BSI rates was further decreased by 78% (1.4 cases per 1000 catheter-days; P <0.001) during period 3. Notably, no CA-BSI were seen in 6 of 12 months (50%) during period 3. Although the mean duration of catheter-days was significantly reduced during period 2 (4.9 ± 1.5 days; P<0.001) and period 3 (4.5 ± 1.4 days; P<0.001) compared to period 1 (5.6 ± 2.4 days), mean duration of catheter-days was not significantly reduced during period 2 (4.9 ± 1.5 days) vs. period 3 (4.5 ± 1.4 days; P=0.71); compliance to all 5 components of maximum sterile barrier precaution (80% vs. 81%; P =0.95), avoidance of femoral catheter insertion (64% vs. 66%; P =0.83) as well as compliance to chlorhexidine-based skin preparation (75% vs 77%; P =0.90) were also not statistically different between period 2 vs. period 3. Compared to period 1, the monthly hospital antibiotic cost for CA-BSI treatment and the hospitalization cost for each patient with CA-BSI during period 2 and 3 were also reduced by 36-49% (P<0.001) and 45-55% (P<0.001), respectively.
Conclusion: Intensified hand hygiene promotion can help further reduced the CA-BSI incidence, cost of antibiotic therapy and cost of hospitalization in a resource-limited setting.
Anucha Apisarnthanarak, MD1, Victoria Fraser, MD2, Kanokporn Thongphubeth, RN3, David Warren, MD4, Chananart Yuekyen, RN3 and  A. Apisarnthanarak, None..
K. Thongphubeth, None..
C. Yuekyen, None..
D. Warren, None..
V. J. Fraser, None., (1)Thammasat University, Pathumthani, Thailand, (2)Washington University School of Medicine, St. Louis, MO, (3)Thammasart University Hospital, Pratumthani, Thailand, (4)Washington University School of Medicine, Saint Louis, MO