Bundle Approach to Reduce Bloodstream Infections in Neutropenic Hematologic

Autor: 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
Jazyk: English<br />Portuguese
Rok vydání: 2015
Předmět:
Zdroj: Acta Médica Portuguesa, Vol 28, Iss 4 (2015)
Druh dokumentu: article
ISSN: 0870-399X
1646-0758
DOI: 10.20344/amp.6002
Popis: 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.
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