Day 1 : Oral Presentations (Theme: Patient Safety)

Event Title

Reducing the rates of central line associated blood stream infection using comprehensive unit-based safety program model in the ICU of a tertiary care hospital in Pakistan

Location

Lecture Hall 2

Start Date

26-1-2013 4:10 PM

Abstract

Background: Current conceptual thinking about patient safety places the primary responsibility for adverse events on deficiencies in system design, organization, and operation rather than on individual practitioners or products. Countermeasures based on changes in the system are, therefore, more productive than those that target the behavior of individuals and their propensity to commit errors. The World Health Organization (WHO) acknowledges that to tackle patient safety internationally, a comprehensive, multifaceted approach involving cultural change, system development and technical expertise is necessary. Central line-associated bloodstream infection (CLABSI) is a primary infection arising from the central line. CLABSI are common, costly, and potentially lethal. A recent meta-analysis by the WHO estimated that pooled cumulative incidence densities of leading causes of HCAIs like central-line associated blood stream infections among adult ICU patients in developing countries was 12.2 per 1000 central line days. Not only are these rates 2-3 fold higher than in ICUs in developed countries, one report showed a crude unadjusted excess mortality of 14.7% to 23.6% from CLABSIs in adult ICU patients.

Methods: The Project was implemented in February 2011 in the 10 bedded adult ICU which receives medical and surgical critically ill patients except patients who have cardiothoracic surgical morbidity. The staff of the unit was given orientation to the CUSP project and patient safety assessment was done. Education and training was initiated for CLABSI to emphasize patient safety; hand washing certification was also done. A team was selected to follow up the patients with central lines and observe their outcomes. Central line insertion kit and checklists were developed and to reinforce the staff compliance with the insertion checklist, spot checks were done. Full body drape of patients during line insertion was reinforced and ultrasound machine was made available in the unit to prevent extra pricks. Femoral line avoidance, skin cleaning with 2 % chlorhexidine, removal of unnecessary lines and use of maximal barrier precautions were the steps that were undertaken at the time of insertion. Maintenance check list with daily goal sheets were observed by the ICU staff. The pre-intervention period was from January, 2009 to January, 2011 and the post-intervention period was from the February, 2011 up till November, 2012.

Results: The number of central line infections for pre-intervention period was 45 with 7925 CL-days and for the post-intervention period there were 14 central line infections with 5129 CL-days. The CLABSI rate decreased from 5.68 per 1000 CL-days (95% confidence interval, 3.75-8.3), for the pre-intervention period, to a post-intervention rate of 2.73 per 1000 CL- days (95% confidence interval, 1.25-3. .99) signifying an approximate 52% reduction in CLABSI incidence from baseline (Incident rate ratio, 0.48; 95% confidence interval, 0.24-0.89; p = 0.013).

Conclusions: A multidimensional strategy like CUSP can be effective in achieving significant and sustained reductions in CLABSI rates.

Key words: patient safety, CUSP, CLABSI

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Jan 26th, 4:10 PM Jan 26th, 4:25 PM

Reducing the rates of central line associated blood stream infection using comprehensive unit-based safety program model in the ICU of a tertiary care hospital in Pakistan

Lecture Hall 2

Background: Current conceptual thinking about patient safety places the primary responsibility for adverse events on deficiencies in system design, organization, and operation rather than on individual practitioners or products. Countermeasures based on changes in the system are, therefore, more productive than those that target the behavior of individuals and their propensity to commit errors. The World Health Organization (WHO) acknowledges that to tackle patient safety internationally, a comprehensive, multifaceted approach involving cultural change, system development and technical expertise is necessary. Central line-associated bloodstream infection (CLABSI) is a primary infection arising from the central line. CLABSI are common, costly, and potentially lethal. A recent meta-analysis by the WHO estimated that pooled cumulative incidence densities of leading causes of HCAIs like central-line associated blood stream infections among adult ICU patients in developing countries was 12.2 per 1000 central line days. Not only are these rates 2-3 fold higher than in ICUs in developed countries, one report showed a crude unadjusted excess mortality of 14.7% to 23.6% from CLABSIs in adult ICU patients.

Methods: The Project was implemented in February 2011 in the 10 bedded adult ICU which receives medical and surgical critically ill patients except patients who have cardiothoracic surgical morbidity. The staff of the unit was given orientation to the CUSP project and patient safety assessment was done. Education and training was initiated for CLABSI to emphasize patient safety; hand washing certification was also done. A team was selected to follow up the patients with central lines and observe their outcomes. Central line insertion kit and checklists were developed and to reinforce the staff compliance with the insertion checklist, spot checks were done. Full body drape of patients during line insertion was reinforced and ultrasound machine was made available in the unit to prevent extra pricks. Femoral line avoidance, skin cleaning with 2 % chlorhexidine, removal of unnecessary lines and use of maximal barrier precautions were the steps that were undertaken at the time of insertion. Maintenance check list with daily goal sheets were observed by the ICU staff. The pre-intervention period was from January, 2009 to January, 2011 and the post-intervention period was from the February, 2011 up till November, 2012.

Results: The number of central line infections for pre-intervention period was 45 with 7925 CL-days and for the post-intervention period there were 14 central line infections with 5129 CL-days. The CLABSI rate decreased from 5.68 per 1000 CL-days (95% confidence interval, 3.75-8.3), for the pre-intervention period, to a post-intervention rate of 2.73 per 1000 CL- days (95% confidence interval, 1.25-3. .99) signifying an approximate 52% reduction in CLABSI incidence from baseline (Incident rate ratio, 0.48; 95% confidence interval, 0.24-0.89; p = 0.013).

Conclusions: A multidimensional strategy like CUSP can be effective in achieving significant and sustained reductions in CLABSI rates.

Key words: patient safety, CUSP, CLABSI