Central Line Associated Blood Stream Infection Rate after Intervention and Comparing Outcome with National Healthcare Safety Network and International Nosocomial Infection Control Consortium Data

Abstract

Background: Benchmarking of central line associated blood stream infection (CLABSI) rates remains a problem in developing countries due to the variations in surveillance practices and/or infection risk as non.availability of national data.

Aim: The aim of the following study was to find out the CLABSI rate before and after central line (CL) bundle intervention and compare the outcome with international surveillance data.

Subjects and Methods: This prospective longitudinal cohort study on adult intensive care unit patients was  conducted at Hera General Hospital,  Makkah Saudi Arabia from January 1 to December 31, 2012. Five key components of bundle were selected; hand hygiene, maximal barrier precautions upon insertion, skin antisepsis, optimum site selection and daily review of line necessity with prompt removal of unnecessary lines. Post-intervention CLABSI rate was compared with National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC) rates. Statistical Package for the Social Sciences (SPSS) 14.0 software (SPSS Inc., 233 South Wacker Drive, 11th floor Chicago, USA) was used for statistical analysis included regression analysis for correlation. Statistical significance was set at P < 0.05.

Results: CLABSI rate was reduced from 10.1 to 6.5 per 1000 CL days after interventions and had significant correlation with overall bundle compliance rate 87.6% (P = 0.02) On benchmarking, CLABSI rate after the intervention was similar to mean pool value of INICC (6.8) while higher than NHSN (3.1). The most common microorganisms isolated were;  methicillin-resistant Staphylococcus aureus (30.8%), Acinetobacter baumanii (23.3%) and Enterococcus faecalis (15.4%).

Conclusion: We found that INICC data was a better benchmarking tool
comparative to NHSN because it represents the countries that are developing the surveillance system. A multicenter national study is recommended.

Keywords: Central line associated blood stream infection, National healthcare safety network, Nosocomial infection control consortium, Saudi Arabia