184. Comprehensive implementation strategy of practice guideline for central line-associated bloodstream infections: Results from prospective multicenter intervention trial in Korea
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: There are a number of evidence based guidelines for central line-associated bloodstream infection (CLA-BSI) prevention, however implementation of these guidelines in real clinical practice is a challenge. The aim of this study is to evaluate the impact of comprehensive approach to lead practice changes in adult intensive care units (ICUs) of Korean Study group for Infection Control and prevention (KOSIC) consortium. 

Methods: This study was a prospective multicenter intervention study of ICU patients with a central catheter. Surveillance for CLA-BSI was conducted using National Health Safety Network case definitions and device-day measurement methods. Interventions included: 1) an education program for ICU staffs every month and regular testing for infection prevention knowledge, 2) application of insertion and maintenance checklists, 3) monitoring compliance to practice guideline by observers, 4) monthly feedback to ICU chief executive on CLA-BSI rates and performance compliance. We compared CLA-BSI rates and compliance to insertion guidelines in pre-intervention period (February to April 2012), versus implementation period (May to October 2012) and post-intervention period (September to December 2012).

Results: Thirty-five ICUs of 15 hospitals were enrolled in this study. Fourteen of the 35 ICUs (40%) were medical ICUs, 4 (11%) surgical ICUs, 9 (26%) neurosurgical ICUs, and 8 (23%) combined medical and surgical ICUs. There was significant decrease in CLA-BSI rate and increase in compliance to guidelines after implementation (P<0.05, table)
Table. Trends of CLA-BSI rates and compliance to guideline 

pre-intervention

period

implementation

period

P

post-intervention

period

P

Catheter-days 28,995 40,386 38,719
CLA-BSI rate (per 1,000 catheter days) 3.52 3.39 0.829 2.30 0.004
Correct answer rate in knowledge test (%) 80 87 <0.001 89 <0.001
Compliance to insertion guidelines
  Hand hygiene (%) 86 90 0.033 91 0.008
  Maximal barrier precaution (%) 60 69 0.001 78 <0.001
  Use >0.5% chlorhexidine tincture (%) 29 40 <0.001 63 <0.001

Conclusion: This study demonstrates that the comprehensive practice guideline implementation strategy was both feasible and efficient in real clinic practice of Korean ICUs on improving performance standards for catheter insertion practice and reducing CLA-BSI rates.

Pyoeng Gyun Choe, MD1, Hye Yun Shin2, Myoung Jin Shin2, Kyoung-Ho Song2, Eu Suk Kim2, Hye Young Jin3, Young Hwa Choi3, Ok Ja Choi4, Hee-Chang Jang4, Kyung-Hwa Park4, Nam Jeong Park5, Kye-Hyung Kim5, Eun Jung Lee6, Su Ha Han7, Eun-Ju Choo7, Hong Bin Kim2 and KOrean Study group for Infection Control and prevention (KOSIC), (1)Seoul National University Hospital, Seoul, South Korea, (2)Seoul National University Bundang Hospital, Seongnam, South Korea, (3)Ajou University Hospital, Suwon, South Korea, (4)Chonnam National University Hospital, Gwangju, South Korea, (5)Pusan National University Hospital, Busan, South Korea, (6)Soonchunhyang University Hospital, Seoul, South Korea, (7)Soonchunhyang University Bucheon Hospital, Bucheon, South Korea

Disclosures:

P. G. Choe, None

H. Y. Shin, None

M. J. Shin, None

K. H. Song, None

E. S. Kim, None

H. Y. Jin, None

Y. H. Choi, None

O. J. Choi, None

H. C. Jang, None

K. H. Park, None

N. J. Park, None

K. H. Kim, None

E. J. Lee, None

S. H. Han, None

E. J. Choo, None

H. B. Kim, None

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