Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: The Spanish experience

Mercedes Palomar, Francisco Álvarez-Lerma, Alba Riera, María Teresa Díaz, Ferrán Torres, Yolanda Agra, Itziar Larizgoitia, Christine A. Goeschel, Peter J. Pronovost

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90 Citations (Scopus)

Abstract

Objective: Prevention of catheter-related bloodstream infection is a basic objective to optimize patient safety in the ICU. Building on the early success of a patient safety unit-based comprehensive intervention (the Keystone ICU project in Michigan), the Bacteremia Zero project aimed to assess its effectiveness after contextual adaptation at large-scale implementation in Spanish ICUs. Design: Prospective time series. Setting: A total of 192 ICUs throughout Spain. Patients: All patients admitted to the participating ICUs during the study period (baseline April 1 to June 30, 2008; intervention period from January 1, 2009, to June 30, 2010). Intervention: Engagement, education, execution, and evaluation were key program features. Main components of the intervention included a bundle of evidence-based clinical practices during insertion and maintenance of catheters and a unit-based safety program (including patient safety training and identification and analysis of errors through patient safety rounds) to improve the safety culture. Measurements and Main Results: The number of catheter-related bloodstream infections was expressed as median and interquartile range. Poisson distribution was used to calculate incidence rates and risk estimates. The participating ICUs accounted for 68% of all ICUs in Spain. Catheter-related bloodstream infection was reduced after 16-18 months of participation (median 3.07 vs 1.12 episodes per 1,000 catheter-days, p < 0.001). The adjusted incidence rate of bacteremia showed a 50% risk reduction (95% CI, 0.39-0.63) at the end of the follow-up period compared with baseline. The reduction was independent of hospital size and type. Conclusions: Results of the Bacteremia Zero project confirmed that the intervention significantly reduced catheter-related bloodstream infection after large-scale implementation in Spanish ICUs. This study suggests that the intervention can also be effective in different socioeconomic contexts even with decentralized health systems. Copyright © 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Original languageEnglish
Pages (from-to)2364-2372
JournalCritical Care Medicine
Volume41
Issue number10
DOIs
Publication statusPublished - 1 Oct 2013

Keywords

  • catheter-related bacteremia
  • intensive care unit
  • multimodal intervention
  • patient safety
  • prevention
  • safety indicators

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