Deen, Siti Norsuhada Mua'ainue
(2019)
Comparison of catheter related bloodstream infection rate before and after the implementation of central venous catheter care bundle in Hospital USM.
Masters thesis, Universiti Sains Malaysia.
Abstract
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.
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