Reducing CR-BSI in a general ICU

Introduction

Central venous catheters (CVCs) are essential for the delivery of medications and fluids in the ICU patient; however, they carry a substantial infection risk. Evidence from a collaborative, cohort study suggests bundled interventions can provide a sustained decrease in infection [1].

Methods

Since December 2009, data have been collected daily on the number of patients with one or more CVC. All positive blood cultures are reviewed monthly against predefined criteria to judge whether these are genuine bacteraemic episodes and thus classified as laboratory-confirmed bloodstream infections. A monthly rate for CR-BSI per 1,000 dwell-days is calculated from these data. Since July 2010, a number of interventions aimed at reducing CR-BSI have been introduced to the ICU.

Results

Data are presented on 15,644 CVC dwell-days over 47 months. Table 1 presents data for three full years and one part year* (January to November 2013). Despite an increase in bed-days per year, there has been a sustained reduction in infection rates and a reduction in dwell-days.

Table 1 Catheter infection rates, APACHE score and bed-days 2010 to 2014

Conclusion

CR-BSI rates of 1.5/1,000 dwell-days in the first year were similar to the post-intervention rate of 1.4 in the Pronovost study [1]. Subsequent rates have reduced, suggesting we are outperforming the secular trend [2]. The proportion of dwell-days to bed-days was reduced, which may suggest a reduction in duration and/or quantity of CVC placements.