Implementation of tailored interventions in a statewide programme to reduce central line-associated bloodstream infections. Issue 3 (November 2018)

• Record Type: Journal Article
• Authors: Assis, D.B.; Madalosso, G.; Padoveze, M.C.; Lobo, R.D.; Oliveira, M.S.; Boszczowski, Í.; Singer, J.M.; Levin, A.S.
• Is Part Of: Journal of hospital infection. Volume 100:Issue 3(2018)
• Page Start: e163
• Page End: e168
• Publication Date: 2018-11
• Subjects: Central line-associated bloodstream infection -- Interventions -- Surveillance; Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2018.04.020
• Languages: English
• ISSNs: 0195-6701

Abstract

Summary: Background: There have been few studies exploring implementation strategies to central line-associated bloodstream infections (CLABSIs) in low- or middle-income countries. Aim: To implement tailored interventions to reduce CLABSI rates in adult intensive care units. Methods: The implementation strategy of the State Health Department was performed in São Paulo State, Brazil, over two cycles. Cycle 1 (56 hospitals) was exploratory and cycle 2 (77 hospitals) was designed to confirm the hypothesis generated by the first cycle, with three phases each (pre-intervention, intervention, post-intervention). Cycles included: evaluation of healthcare workers' knowledge, observation of practices, and CLABSI rates monthly report. In cycle 1, a log–normal mixed model was used to select variables significantly associated with the reduction of CLABSI. In cycle 2, CLABSI rates were evaluated. Findings: Healthcare workers' practices improved after intervention. In cycle 1, reduction of CLABSI rates was more pronounced in hospitals with initial CLABSI rates >7.4 per 1000 catheter-days ( P < 0.001) and those that introduced the use of peripherally inserted central catheters ( P = 0.01). For hospitals with high CLABSI initial rates, simulation demonstrated that the rates were expected to decrease by 36% (95% CI: 9–63), no matter the type of intervention. In cycle 2, there was an overall decrease in CLABSI rates during the intervention period; whereas the mean rate fell further post-intervention, rates at the 90 th percentile increased. Conclusion: The implementation strategy may have had an effect on infection rates independently of the specific interventions implemented; however, the sustainability of reduction in the post-intervention period remains a challenge.