Effectiveness of a care bundle to reduce central line-associated bloodstream infections.

OBJECTIVE: To determine the effectiveness of a care bundle, with a novel line maintenance procedure, in reducing the rate of central line-associated bloodstream infection (CLABSI) in the intensive care unit (ICU). DESIGN, PARTICIPANTS AND SETTING: Before-and-after study using CLABSI data reported to the Victorian Healthcare Associated Infection Surveillance System (VICNISS), in adult patients admitted to a tertiary adult ICU in regional Victoria between 1 July 2006 and 30 June 2014. VICNISS-reported CLABSI cases were reviewed for verification. An intervention was implemented in 2009. INTERVENTION: The care bundle introduced in 2009 included a previously established line insertion procedure and a novel line maintenance procedure comprising Biopatch, daily 2% chlorhexidine body wash, daily ICU central line review, and liaison nurse follow-up of central lines. MAIN OUTCOME MEASURES: CLABSI rate (cases per 1000 central line days). RESULTS: The average CLABSI rate fell from 2.2/1000 central line days (peak of 5.2/1000 central line days in quarter 4, 2008) during the pre-intervention period to 0.5/1000 central line days (0/1000 central line days from July 2012 to July 2014) during the post-intervention period. CONCLUSION: Our study suggests that this care bundle, using a novel maintenance procedure, can effectively reduce the CLABSI rate and maintain it at zero out to 2 years.

Implementation and outcomes of a severe sepsis protocol in an Australian tertiary hospital.

OBJECTIVE: To evaluate the effect of implementation of a sepsis protocol. DESIGN: Before and after cohort study. SETTING: Level III ICU in a tertiary regional hospital, February - July, 2006 (before intervention) and 2007 (after). PARTICIPANTS: Adult patients who fulfilled criteria for severe sepsis or septic shock within 48 hours of ICU admission. INTERVENTION: Implementation of a locally modified sepsis protocol. MAIN OUTCOME MEASURES: Delivery of process of care components, and ICU and hospital mortality. RESULTS: A total of 110 patients were included in the study: 44 in the pre-protocol group, and 66 in the post-protocol group. Demographic variables and severity of illness variables were similar in the two groups except for a lower incidence of respiratory sepsis in the post-protocol group. Post-protocol, there was a shorter time to initiation of appropriate antibiotics, and an increase in the use of vasopressors, deep vein thrombosis prophylaxis, and nutritional support, with no difference in ICU or hospital mortality. There was no difference in resuscitation endpoints at 6, 24, and 72 hours. CONCLUSIONS: Implementation of a sepsis protocol led to a change in the delivery of care with no reduction in mortality in patients with severe sepsis and septic shock admitted to a Level III ICU in a tertiary hospital.