Bundle Approach to Reduce Bloodstream Infections in Neutropenic Hematologic

Jose Manuel Martinez, Luís Leite, Daniela França, Rita Capela, Luísa Viterbo, Natalina Varajão, Ângelo Martins, Isabel Oliveira, Nélson Domingues, Ilídia Moreira, Ana Santo, Filipe Trigo, Jose Mariz

Abstract


Introduction: The objective of the study was to reduce, by a bundle of interventions, the global bloodstream infections and catheterrelated bloodstream infections rates in neutropenic hematology patients with a long-term central venous catheter.
Material and Methods: This was a non-randomized prospective study. It was conducted in a 20-bed hematology oncology unit (Portuguese Institute of Oncology, Porto, Portugal) between 1st of August 2010 and 31st of January 2012. In this period we introduced a bundle of interventions (study group) and compared the results with the six months prior to implementation (control group). The interventions consisted in the use of a neutral pressure mechanical valve connector instead of a positive pressure mechanical valve connector, a more frequent change of this connector and a more efficient clean solution. One hundred and sixteen hematology patients with a long-term central venous catheter at time superior of 72 h, with 8 867 central venous catheter days [6 756 central venous catheter days in the study group and 2 111 central venous catheter days in the control group] were included in the study.
Results: A significant reduction in bloodstream infections rates and catheter-related bloodstream infections rates was achieved. Bloodstream infections rates: [32.69 (control group) vs. 9.43 (study group)], incidence reduction 71% [relative risk 0.2886, CI 95% (0.1793 – 0.4647), p < 0.001] and catheter-related bloodstream infections rates: [17.53 (control group) vs. 4.73 (study group)], incidence reduction 71% [relative risk 0.2936, CI 95% (0.1793 – 0.5615), p < 0.014]. No significant difference (p > 0.05) was found in the neutrophil count at the time of blood culture samples between groups: 69% (< 500 neutrophils/mm3) [71% (study group) vs. 68% (control group)].
Conclusions: The introduction of this bundle of interventions based on the variables of patient, product and practice, supported by the Healthcare and Technology Synergy framework, quickly resulted in a significant reduction of bloodstream infections and catheterrelated bloodstream infections rates.


Keywords


Catheter-Related Infections; Catheterization, Central Venous; Neutropenia.

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