Multimodal strategy to reduce central line-associated bloodstream infections in the ICU of a tertiary teaching hospital

Abstract

Background: Central line-associated bloodstream infections (CLABSI) in the intensive care unit (ICU) are a serious preventable hospital acquired infection which can result in increasing mortality, morbidity and health care costs. In this study, we aim to determine the effect of implementing a multimodal strategy on reducing the incidence rates of CLABSIs in the ICU of a tertiary teaching hospital.Methods and materials: All patients who had a central venous catheter (CVC) inserted in in the University Malaya Medical Centre (UMMC) ICU from January 2018 to June 2019 were prospectively followed up by the infection control nurse until removal of CVC. The study periods were divided into pre-intervention (January 2018-August 2018) and the post intervention (September 2018-August 2019) periods. CLABSI was diagnosed based on the definition by Centers for Disease Control and Prevention (CDC). Data was collected using a standardized CLABSI surveillance form and analyzed using Statistical Package for the Social Sciences (SPSS) version 20. In September 2018, a multidisciplinary quality improvement team was formed consisting of interventionists, the infection control team, an infectious diseases physician, ICU nurses and medical assistants. A baseline assessment of current practice was done and gaps in practice were identified. Following that, the team carried out several interventions including education, training, regular audits on line care, immediate feedback and conducting mini root cause analysis for every CLABSI identified. Additionally all staff in ICU were required to complete the online Hand Hygiene Australia module.Results: In the pre intervention period, the rate of CLABSI in ICU was high at 8.89/1000 catheter days. Following the multimodal interventions in September 2018, the rates of CLABSI in ICU reduced to 3.02/1000 catheter days in the post intervention period. Conclusion:Implementing multimodal strategies with a multidisciplinary team in the ICU with hands on training, and regular audits is effective in reducing the incidence rates of CLABSI.