11-component CLABSI reduction bundle
Abstract:
Background: Central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs) across Latin America exceed those in high-income countries significantly.
Methods: We implemented the INICC multidimensional approach, incorporating an 11-component bundle, in 122 ICUs spanning nine Asian countries. We computed the CLABSI rate using the CDC/NSHN definition and criteria. The CLABSI rate per 1000 CL-days was calculated at baseline and throughout different phases of the intervention, including the 2nd month, 3rd month, 4-16 month, and 17-29 month periods. A two-sample t-test was employed to compare baseline CLABSI rates with intervention rates. Additionally, we utilized a generalized linear mixed model with a Poisson distribution to analyze the association between exposure and outcome.
Results: A total of 124,946 patients were hospitalized over 717,270 patient-days, with 238,595 central line (CL)-days recorded. The rates of CLABSI per 1000 CL-days significantly decreased from 16.64 during the baseline period to 6.51 in the 2nd month (RR = 0.39; 95% CI = 0.36-0.42; p < 0.001), 3.71 in the 3rd month (RR = 0.22; 95% CI = 0.21-0.25; p < 0.001), 2.80 in the 4-16 month (RR = 0.17; 95% CI = 0.15-0.19; p < 0.001), and 2.18 in the 17-29 month (RR = 0.13; 95% CI = 0.11-0.15; p < 0.001) intervals. A multilevel Poisson regression model demonstrated a sustained, continuous, and statistically significant decrease in ratios of incidence rates, reaching 0.35 (p < 0.0001) during the 17-29 month period. Moreover, the all-cause in-ICU mortality rate significantly decreased from 13.23% to 10.96% (p = 0.0001) during the 17-29 month period.
Conclusions: Our intervention led to an 87% reduction in CLABSI rates, with a 29-month follow-up.
Reference:
Rosenthal VD, Yin R, Myatra SN, Divatia JV, Biswas SK, Shrivastava AM, Perez V, Wang QY, Todi SK, Tang SF, Tai CW, Lee PC, Sengupta D, Sarma S, Sandhu K, Rodrigues C, Nag B, Mohd-Basri MN, Mehta Y, Kharbanda M, Kansal S, Jain AC, Davaadagva N, Chuah SL, Low MSY, Gan CS, Bt Madzlan Kushairi M, Bhattacharyya M, Bhakta A, Begzjav T, Bat-Erdene B, Bali RK, Badyal B, Arora A, Arjun R, Tao L, Jin Z, Chawla R. Evaluating the outcome of a bundle with 11 components and the INICC multidimensional approach in decreasing rates of central line-associated bloodstream infections across nine Asian countries. J Vasc Access. 2024 Mar 27:11297298241242163. doi: 10.1177/11297298241242163. Epub ahead of print. PMID: 38539085.