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IMPROVING PATIENT SAFETY IN LATIN AMERICA: A MULTI-COUNTRY QUALITY IMPROVEMENT COLLABORATIVE PROJECT TO REDUCE THE INCIDENCE OF CLABSI IN ICUS
  1. Jafet Arrieta1,
  2. Marcela Colmenares2,
  3. Pedro Delgado3,
  4. Ezequiel Garcia-Elorrio4,
  5. Carolina Giuffre5,
  6. Dolores Macchiavello6,
  7. Nuria Mora7,
  8. Carola Orrego7,
  9. Viviana Rodriguez7
  1. 1Harvard T.H. Chan School of Public Health, USA
  2. 2Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
  3. 3Institute for Healthcare Improvement, USA
  4. 4Hospital Britanico de Buenos Aires, Argentina
  5. 5Institute for Clinical Effectiveness and Health Policy, Argentina
  6. 6Avedis Donabedian Research Institute/University Autonomous of Barcelona, Spain
  7. 7Institute for Clinical Effectiveness and Health Policy, Argentina

Abstract

Background Central line-associated bloodstream infections (CLABSI) are the leading cause of healthcare-associated bloodstream infections, prolonging hospitalizations, and increasing healthcare costs, morbidity and mortality. The CLABSI incidence for Latin America has been estimated at 7.6 episodes per 1,000 central line days. In developing countries, CLABSI are usually the result of failing to follow evidence-based practices.

Objectives The ‘Goodbye Bacteremia' collaborative aimed at reducing the CLABSI incidence by 50% or to less than 2 episodes per 1,000 central line days from baseline within 12 months of the implementation of the collaborative.

Methods Design: Uncontrolled before-and-after CLABSI rates comparison. Setting: 83 ICUs from 32 hospitals from five Latin American countries.

Intervention: We used a quality-improvement collaborative to promote the adoption of bundles of care for the insertion and maintenance of central lines, coupled with education through virtual bi-weekly learning sessions, from June 2014 to June 2015.

Measures: Self-reported CLABSI incidence; percentage compliance with central line insertion bundle; percentage compliance with central line maintenance bundle.

Results The overall reduction on the CLABSI incidence was 26% (incidence rate [IR], 0.78; 95% CI 0.61, 0.92) from 2.58 episodes per 1,000 central line days at baseline to 2.02 episodes per 1,000 central line days (p<0.01) during the collaborative. The average percentage compliance increased from 67.8% at baseline to 86.0% for the insertion bundle, and from 82.3% at baseline to 90.9% at the end of the collaborative for the maintenance bundle.

Conclusions Evidence-based interventions and multi-country collaborative work contributed to a significant reduction in the incidence of CLABSI in Latin American ICUs.

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