Impact of a National Multimodal Intervention to Prevent Catheter-Related Bloodstream Infection in the ICU: The Spanish Experience.
Palomar, Mercedes MD, PhD 1; Alvarez-Lerma, Francisco MD, PhD 2; Riera, Alba RN 3; Diaz, Maria Teresa RN 4,+; Torres, Ferran MD, PhD 5; Agra, Yolanda MD, PhD 6; Larizgoitia, Itziar MD, MPH, PhD 4; Goeschel, Christine A. ScD, MPA, MPS, RN 7; Pronovost, Peter J. MD, PhD 7; on behalf of the Bacteremia Zero Working Group
Critical Care Medicine.
41(10):2364-2372, October 2013.
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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.
(C) 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins