How do bundles reduce CLABSI rates in hematology patients

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Abstract:

INTRODUCTION: The objective of the study was to reduce, by a bundle of interventions, the global bloodstream infections and catheter related bloodstream infections rates in neutropenic hematology patients with a long-term central venous catheter.

MATERIAL AND METHODS: This was a non-randomized prospective study. It was conducted in a 20-bed hematology oncology unit (Portuguese Institute of Oncology, Porto, Portugal) between 1st of August 2010 and 31st of January 2012. In this period we introduced a bundle of interventions (study group) and compared the results with the six months prior to implementation (control group). The interventions consisted in the use of a neutral pressure mechanical valve connector instead of a positive pressure mechanical valve connector, a more frequent change of this connector and a more efficient clean solution. One hundred and sixteen hematology patients with a long-term central venous catheter at time superior of 72 h, with 8 867 central venous catheter days [6 756 central venous catheter days in the study group and 2 111 central venous catheter days in the control group] were included in the study.

RESULTS: A significant reduction in bloodstream infections rates and catheter-related bloodstream infections rates was achieved. Bloodstream infections rates: [32.69 (control group) vs. 9.43 (study group)], incidence reduction 71% [relative risk 0.2886, CI 95% (0.1793 – 0.4647), p < 0.001]and catheter-related bloodstream infections rates: [17.53 (control group) vs. 4.73 (study group)], incidence reduction 71% [relative risk 0.2936, CI 95% (0.1793 – 0.5615), p < 0.014]. No significant difference (p > 0.05) was found in the neutrophil count at the time of blood culture samples between groups: 69% (< 500 neutrophils/mm3) [71% (study group) vs. 68% (control group)].

CONCLUSIONS: The introduction of this bundle of interventions based on the variables of patient, product and practice, supported by the Healthcare and Technology Synergy framework, quickly resulted in a significant reduction of bloodstream infections and catheter related bloodstream infections rates.

Reference:

Martinez, J.M., Leite, L., França, D., Capela, R., Viterbo, L., Varajão, N., Martins, Â., Oliveira, I., Domingues, N., Moreira, I., Santo, A., Trigo, F. and Mariz, J. (2015) Bundle Approach to Reduce Bloodstream Infections in Neutropenic Hematologic. Acta Médica Portuguesa. 28(4), p.474-479.

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