Impact of intensified prevention measures on rates of hospital-acquired bloodstream infection in medical- surgical intensive care units, Israel, 2011 to 2019

Background: Central line-associated bloodstream infection (CLABSI) is among the most common pre-ventable infectious complications in patients in inten-sive care units (ICU). In 2011, the Israel National Center for Infection Control initiated a nationwide CLABSI pre-vention programme.Aim: To evaluate the impact of different components of the programme on CLABSI and non-CLABSI rates in medical-surgical ICUs.Methods: We included data collected from all 29 medical-surgical ICUs in Israel from November 2011 to December 2019. The study period was divided into three phases: I (baseline, initial CLABSI preven-tion guidelines introduced, initial feedback on rates provided), II (initial guidelines widely implemented, surveillance undertaken, feedback continued) and III (after implementation of additional prevention meas-ures). Interrupted time series analysis was used to compare CLABSI and non-CLABSI rates during the three phases.Results: The pooled mean (SD) incidence of CLABSI per 1,000 central line-days dropped from 7.4 (0.38) in phase I to 2.1 (0.13) in phase III (p < 0.001). The inci-dence rate ratio (IRR) was 0.63 (95% CI: 0.51-0.79) between phases I and II, and 0.78 (95% CI: 0.59-1.02) between phases II and III. The pooled mean (SD) inci-dence of non-CLABSI per 1,000 patient-days declined from 5.3 (0.24) in phase I to 3.4 (0.13) in phase III (p < 0.001).Conclusion: National CLABSI prevention guidelines, surveillance and feedback resulted in significant reductions in CLABSI and non-CLABSI rates. In the wake of further interventions, significant reduction was achieved in ICUs reporting improvement in the uptake of additional prevention measures.

Automated summary

The nationwide CLABSI prevention program in Israel, consisting of guidelines, surveillance, and feedback, resulted in significant reductions in CLABSI and non-CLABSI rates.