Comparison of catheter related bloodstream infection rate before and after the implementation of central venous catheter care bundle in Hospital USM

• Main Author: Deen, Siti Norsuhada Mua'ainue
• Format: Thesis
• Language: English
• Published: 2019
• Subjects: R Medicine
• Online Access: http://eprints.usm.my/48482/1/Dr.%20Siti%20Norshuhada-24%20pages.pdf; http://eprints.usm.my/48482/

Introduction: Catheter related bloodstream infection (CRBSI) increases risk of bloodstream infections and sepsis-related death which leads to longer hospitalisation and created significant medical and economic burden. The implementation of the CVC Care Bundle has shown to decrease the incidence of CRBSIs worldwide. This study aimed to analyse the incidence rate of CRBSI following implementation of CVC Care Bundle in Hospital USM. Methodology: This was a cohort study conducted in all patients admitted to Hospital USM within April 2016 till December 2017 who had CVC inserted on them. Patient who aged more than 18 years old and newly admitted patient for various indication of catheterisation were included in the study, whereas patients who already had other central venous devices were excluded in the study. Data of CRBSI cases from April 2016 to December 2016 was taken as pre-intervention data. Intervention was done for three months from January 2017 to March 2017 followed by post-intervention from April 2017 to December 2017. Implementation that was done include strict practices of CVC Care Bundle based on CDC guidelines in year 2009. Patient’s information was obtained from medical record and laboratory information system. The results were presented as descriptive and statistically analysed using SPSS version. Comparison of incidence rate of CRBSI was done using 2-Sample Poisson Rate as a p<0.05 was considered statistically significant. Result: A total of 126 cases of CRBSI were documented which consist of 57% (n=72) and 43% (n=54) patients pre and post-intervention respectively. The incidence rate of CRBSI was 0.88 per 100 admission days, compared to 0.39 per 100 admission days during post-intervention. The result was statistically significant (p <0.001). The incidence of CRBSI based on 1000 catheter days was of 18.1 (95% confidence interval: 13.3-22.0) per 1000 catheter-days. Gram-positive organism was the most common causative organism during pre-intervention whereas Gram-negative organism dominating during post-intervention. The most common organisms isolated were Staphylococcus aureus (50%, n=11), Enterococcus fecalis (18.2%, n=11), and Pseudomonas aeruginosa (15.4%, n=4). The compliance rates to CVC care bundle were in the range 85-100%. Conclusion: Incidence rate of CRBSI reduced following the implementation of CVC Care Bundle. Compliance rates towards CVC care bundle were excellent. Gram-negative organism was the most common causative organism following intervention.