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Bundles have been developed to facilitate the application of infection control guidelines. Investigators from Hospital Universitario Austral in Pilar, Argentina report that because the rates of central line-associated bloodstream infections (CLABSIs) in their institution were above the international standards, a specific bundle was implemented through a multi-modal approach. Quiros, et al. sought to describe the strategy of bundle implementation for prevention of CLABSI and to estimate its impact.
Since March 2010 the following measures were implemented at the ICUs to prevent CLABSI: use central venous catheters only if strictly necessary; avoiding the femoral site if possible; hand hygiene with alcohol-gel before insertion; using full-barrier precautions during the insertion of central venous catheters; cleaning the skin with chlorhexidine (2 percent) and removing unnecessary catheters. The implementation was carried out through the model of "5Es" (Engage, Education, Execution, Evaluation and Encouragement). The rate of CLABSI during the intervention period (March 2010 through February 2011) was compared with the average of the 12 months prior to implementation. For economic impact analysis an attributable cost of U.S. $5,500 was used.
The incidence rate of CLABSI at the baseline period was 6.84 events per 1,000 device-days in comparison with 2.70 events per 1,000 device-days during implementation period (RR 0.40; 95% CI 0.22 to 0.69, p<0,01). There were no changes in the utilization ratio between both periods (0.45 [6429/14222] and 0.44 [7025/16077], respectively). During the implementation period the level of adherence rose to more than 90 percent in all bundle components. While the annual incremental cost to prevent CLABSI was U.S. $28,300, the overall net savings was U.S. $130,500.
The researchers say effective implementation of this bundle in their hospital reduced the CLABSI rate with a significant net savings. Their research was presented at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland, June 29-July 2, 2011.
Reference: RE QuirÃ³s, L Fabbro and A Novau. Impact of bundle for central line associated bloodstream infections prevention. Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):O11doi:10.1186/1753-6561-5-S6-O11