190. A state-wide program to decrease rates of catheter-related bloodstream infections in adult intensive care unit : low cost interventions, great results
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • abstract41414_presentationnumber190.PNG (640.3 kB)
  • Background:

    Evaluate the impact of interventions in reducing BSI rates in adult intensive care units

    Methods:

    Study conducted in ICU hospitals of São Paulo State, Brazil. Stratified sampling was used and included 56 hospitals. Hospitals were requested to form a work team that was summoned to a meeting to debate problems and a work plan. Each hospital applied a questionnaire to HCWs and observation of practices was done. Compiled data was fed back to the teams in a 2nd meeting in which 4 interventions strategies were defined. In the next phase, each work team chose and implemented the strategies that suited their ICU. A 2nd observation period followed and the teams met on 2 further occasions to discuss difficulties and results. During the study period (1 year) and after 6 months rates of BSI were registered and compared.

    Results:

    Median number of ICU beds was 12 (5-61) and work teams had 6 members (2-26).

    Questionnaires (n: 2186) - Insertion: Hand hygiene (HH) (99% correct answers); skin prep (70%); maximal barrier (96%); ample drapes (85%); insertion site choice (74%); CVC care: hand hygiene (96%) hub disinfection (92%); early removal (61%).

    Strategies used: alcohol gel implementation (48%); CVC insertion kit implementation (75%); PICC use (14%); training on choice of insertion site, skin prep and CVC care (232 sessions; 1573 HCW).

    Table 1: Observations pre and post intervention

    Practices

    pre (n)

    %

    post (n)

    %

    p

    Subclavian insertion

    907/1864

    49

    813/1432

    57

    0.001

    Hub disinfection

    2539/4017

    63

    3490/4395

    79

    0.001

    HH before CVC care

    3530/4595

    77

    4126/4512

    91

    0.001

    HH before dressing

    2187/2463

    89

    1729/1809

    97

    0.001

     

    Figure 1: BSI rates per trimester (tri0: pre-intervention period; tri1, 2 and 3: intervention period; tri 4 and 5: post-intervention period)

    Figure 2. BSI rates per trimester according to hospitals' pre-intervention BSI rates (1: pre-intervention period; 2, 3 and 4: intervention period; 4 and 5: post-intervention period).

    Conclusion:

    • There was an improvement in HCW practices: subclavian insertion site, hub disinfection and hand hygiene
    • There was a decrease in BSI rates: hospitals with higher initial BSI rates had the greatest decrease
    Denise Assis1,2, Geraldine Maddalozzo2, Matias Salomão3, Renata Lobo4, Maria Clara Padoveze, RN, PhD5, Maura Oliveira1 and Anna Sara Levin, MD, PhD6, (1)Hospital das Clínicas da FMUSP, São Paulo, Brazil, (2)Centro de Vigilância Epidemiológica, State Health Department, São Paulo, Brazil, (3)Hospital das Clínicas da FMUSP, São Paulo , Brazil, (4)Hospital das Clínicas da FMUSP, Sâo Paulo, Brazil, (5)Nursing School of University of sao Paulo, São Paulo, Brazil, (6)University of São Paulo, São Paulo, Brazil

    Disclosures:

    D. Assis, None

    G. Maddalozzo, None

    M. Salomão, None

    R. Lobo, None

    M. C. Padoveze, None

    M. Oliveira, None

    A. S. Levin, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.