Effectiveness of a catheter-associated bloodstream infection bundle in a Thai tertiary care center: a 3-year study.

Background: We sought to determine the long-term impact of "bundled" infection control interventions on the rates of catheter-associated bloodstream infection (CA-BSI) in a middle-income country. Setting: A 500-bed tertiary care center in Thailand. Methods: A 3-year, hospital-wide, prospective quasi-experimental study was conducted for 1 year before the intervention (period 1), 1 year after implementation of the CA-BSI bundle (period 2), and at a 1-year follow-up after the intervention with intensified hand hygiene promotion (period 3). Results: In period 1, 88 episodes of CA-BSI (14 cases per 1000 catheter-days) were recorded. During period 2, the CA-BSI rate decreased by 54.1% (6.4 cases per 1000 catheter-days; P < .001). Compared with period 1 (8% adherence), hand hygiene adherence was improved in period 2 (24%; P < .001) and period 3 (54%; P < .001). The CA-BSI rate was further decreased by 78% (1.4 cases per 1000 catheter-days; P < .001) during period 3. Notably, no CA-BSIs were seen in 6 of the 12 months (50%) of period 3. Compared with period 1, the mean number of catheter-days was significantly reduced in period 2 (4.9 +/- 1.5 days; P < .001) and period 3 (4.1 +/- 1.1 days; P < .001). Conclusion: Bundled infection control practices are feasible and effective in sustaining reduced incidence of CA-BSI in patients with central venous catheters in a resource-limited setting. Copyright (C) 2010 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. (Am J Infect Control 2010; 38:449-55.)