P Saliba1, A Hornero2, G Cuervo1, I Grau1, E Jimenez1, D Berbel3, P Martos4, J M Verge4, C Tebe5, J M Martínez-Sánchez6, E Shaw1, L Gavaldà7, J Carratalà8, M Pujol1. 1. Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. 2. Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. Electronic address: chornero@bellvitgehospital.cat. 3. Department of Microbiology, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. 4. Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain. 5. Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. 6. Universitat Internacional de Catalunya (UIC), Barcelona, Spain. 7. Department of Preventive Medicine-Hospital Hygiene, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. 8. Department of Infectious Diseases, Bellvitge University Hospital, L'Hospitalet del Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Short-term peripheral venous catheters are a significant source of healthcare-acquired bloodstream infections and a preventable cause of death. AIM: To assess the effectiveness of interventions applied to reduce the incidence and mortality associated with short-term peripheral venous catheter-related bloodstream infections (PVCR-BSIs). METHODS: The intervention included continuous PVCR-BSI surveillance, implementation of preventive measures related to catheter insertion and maintenance in accordance with evidence-based recommendations and the hospital's own data, front-line staff educational campaigns, and assessment of adherence to hospital guidelines by ward rounds. A Poisson regression model was used to estimate the trend of rate per year. FINDINGS: From January 2003 to December 2016, 227 episodes of PVCR-BSI were identified among hospitalized patients at a university hospital. The mean age of patients was 67 years (standard deviation 14 years), 69% were male and the median Charlson score was 3 (interquartile range 2-5). Staphylococcus aureus caused 115 (50.7%) episodes. Thirty-day mortality was 13.2%. After implementation of the intervention, the incidence of PVCR-BSIs decreased significantly from 30 episodes in 2003 (1.17 episodes/10,000 patient-days) to eight episodes in 2016 (0.36/10,000 patient-days). The number of episodes caused by S. aureus decreased from 18 episodes in 2003 (0.70/10,000 patient-days) to three episodes in 2016 (0.14/10,000 patient-day), and mortality decreased from seven cases in 2003 (0.27/10,000 patient-days) to zero cases in 2016 (0.00/10,000 patient-days). CONCLUSIONS: Surveillance, implementation of a multi-modal strategy and periodical assessment of healthcare workers' adherence to hospital guidelines led to a sustained reduction in PVCR-BSIs. This reduction had a major impact on S. aureus BSI rates and associated mortality.
BACKGROUND: Short-term peripheral venous catheters are a significant source of healthcare-acquired bloodstream infections and a preventable cause of death. AIM: To assess the effectiveness of interventions applied to reduce the incidence and mortality associated with short-term peripheral venous catheter-related bloodstream infections (PVCR-BSIs). METHODS: The intervention included continuous PVCR-BSI surveillance, implementation of preventive measures related to catheter insertion and maintenance in accordance with evidence-based recommendations and the hospital's own data, front-line staff educational campaigns, and assessment of adherence to hospital guidelines by ward rounds. A Poisson regression model was used to estimate the trend of rate per year. FINDINGS: From January 2003 to December 2016, 227 episodes of PVCR-BSI were identified among hospitalized patients at a university hospital. The mean age of patients was 67 years (standard deviation 14 years), 69% were male and the median Charlson score was 3 (interquartile range 2-5). Staphylococcus aureus caused 115 (50.7%) episodes. Thirty-day mortality was 13.2%. After implementation of the intervention, the incidence of PVCR-BSIs decreased significantly from 30 episodes in 2003 (1.17 episodes/10,000 patient-days) to eight episodes in 2016 (0.36/10,000 patient-days). The number of episodes caused by S. aureus decreased from 18 episodes in 2003 (0.70/10,000 patient-days) to three episodes in 2016 (0.14/10,000 patient-day), and mortality decreased from seven cases in 2003 (0.27/10,000 patient-days) to zero cases in 2016 (0.00/10,000 patient-days). CONCLUSIONS: Surveillance, implementation of a multi-modal strategy and periodical assessment of healthcare workers' adherence to hospital guidelines led to a sustained reduction in PVCR-BSIs. This reduction had a major impact on S. aureus BSI rates and associated mortality.