Central-lineÐassociated bloodstream infections comprise 35% of acquired BSI in Israeli intensive care units (ICUs). In 2012, an ongoing national intervention was initiated, including insertion and maintenance bundles, education, outcome surveillance and feedback on CLABSI rates. Following the intervention, a significant decrease in both total BSI and CLABSI rates were observed. However; CLABSI rates remained high in some units. The aims of the study were: 1) to assess the association between hospitals' implementation of prevention practices and CLABSI incidence in general ICUs and 2) to identify which prevention practices were most important for reducing CLABSI incidence.
A national, prospective surveillance program was implemented in 2012. Since May 2016, monthly individual data replaced prior aggregated reports. The data includes all positive blood cultures, admission and discharge dates, signs/symptoms and diagnostic procedures dates and presence of central lines. In June 2017, an online survey assessing infection prevention practices in general ICUs was sent to all acute care hospitals. Based on the results of the survey, a 14-element prevention score was created that included presence of unit champions, periodic educational sessions, insertion and maintenance practices, and conducting of routine audits. The association between the prevention score and CLABSI rates during the first 6 months of 2017 was assessed using the Spearman correlation test. Negative binomial regression was used to calculate incident rate ratio.
CLABSI rates in 26 general ICUs varied between 0.0 and 17.0 per 1000 catheter days. Higher prevention scores were associated with lower CLABSI rates (Spearman's rho = -0.51, P=0.01; Figure1). Significant lower rates were observed in ICUs that had wards champions (IRR 0.48 CI 95% 0.32-0.73, p=0.001) monitored compliance to preventive insertion measures (IRR 0.36, CI 95% 0.20-0.64, p=0.001), used ultrasound for insertion (IRR 0.48, CI 95% 0.29-0.81, p=0.006) and used simulations for teaching (IRR 0.41, CI 95% 0.24-0.70; p=0.001).
More complete implementation of a multi-faceted intervention was associated with lower CLABSI rates in Israeli ICUs.
D. Ben David,
E. Solter, None
E. Temkin, None
Y. Carmeli, None
M. J. Schwaber, None