A collaborative effort in 83 intensive care units in Latin America effectively implemented a performance improvement process called Adios CLABSIs. This effort instituted virtual education of infection prevention for insertion and care bundles for maintenance. In the first phase 53% reduction of CLABSIs in 39 units and second phase 22% in 83 units from 4.59/1000 catheter days to a statistically significant 2.02/1000 catheter days. The improvement effort demonstrated the effectiveness of education coupled with care practices and continuous feedback to improve outcomes for patients. – Nancy Moureau, PhD, RN, CRNI, CPUI, VA-BC
QUALITY PROBLEM: The incidence of central line-associated bloodstream infections (CLABSI) in Latin America has been estimated at 4.9 episodes per 1000 central line (CL) days, compared to a pooled incidence of 0.9 in the United States. CLABSI usually result from not adhering to standardized health procedures and can be prevented using evidence-based practices.
INITIAL ASSESSMENT: The first phase of the ‘Adiós Bacteriemias’ Collaborative was implemented in 39 intensive care units (ICUs) from Latin America from September 2012 to September 2013 with a 56% overall reduction in the incidence of CLABSI.
CHOICE OF SOLUTION: Bundles of care for the processes of insertion and maintenance of CLs have proven to be effective in the reduction of CLABSI across different settings.
IMPLEMENTATION: Building on the results of the first phase, we implemented a second phase of the ‘Adiós Bacteriemias’ Collaborative between June 2014-July 2015. We adapted the Breakthrough Series (BTS) Collaborative model to guide the adoption of bundles of care for CLABSI prevention through virtual learning sessions and continuous feedback.
EVALUATION: Eighty-three ICUs from five Latin American countries actively reported process and outcome measures. The overall reduction in the CLABSI incidence rate was 22% (incidence rate 0.78; 95% CI 0.65, 0.95), from 2.58 episodes per 1000 CL days at baseline to 2.02 episodes per 1000 CL days (P < 0.01) during the intervention period. LESSONS LEARNED: Adiós Bacteriemias was effective in reducing the incidence of CLABSI and improving the adherence to good practices for CL insertion and maintenance processes in participating ICUs in Latin America.
Arrieta, J., Orrego, C., Macchiavello, D., Mora, N., Delgado, P., Giuffré, C., García Elorrio, E. and Rodriguez, V. (2019) ‘Adiós Bacteriemias’: a multi-country quality improvement collaborative project to reduce the incidence of CLABSI in Latin American ICUs. International Journal for Quality in Health Care. June 13th. doi: 10.1093/intqhc/mzz051. [Epub ahead of print]
Published by IV Team June 26, 2019