PT  - JOURNAL ARTICLE
AU  - Poonam Gupta
AU  - Mincy Thomas
AU  - Ashfaq Patel
AU  - Reeba George
AU  - Leena Mathews
AU  - Seenu Alex
AU  - Siji John
AU  - Cherlyn Simbulan
AU  - Ma Leni Garcia
AU  - Sara Al-Balushi
AU  - Mawahib El Hassan
TI  - Bundle approach used to achieve zero central line-associated bloodstream infections in an adult coronary intensive care unit
AID  - 10.1136/bmjoq-2020-001200
DP  - 2021 Feb 01
TA  - BMJ Open Quality
PG  - e001200
VI  - 10
IP  - 1
4099  - http://bmjopenquality.bmj.com/content/10/1/e001200.short
4100  - http://bmjopenquality.bmj.com/content/10/1/e001200.full
SO  - BMJ Open Qual2021 Feb 01; 10
AB  - Background Central venous catheterisation is commonly used in critical patients in intensive care units (ICU). It may cause complications and attribute to increase mortality and morbidity. At coronary ICU (CICU) of cardiac hospital, central line-associated bloodstream infection (CLABSI) rate was 2.82/1000 central line days in 2015 and 3.11/1000 central line days in 2016. Working in collaboration with Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in the form of bundles in with the aim of eliminating CLABSI in CICU.Methods In collaboration with IHI, we worked on this initiative as multidisciplinary team and tested several changes. CLABSI prevention bundles were tested and implemented, single kit for line insertion, simulation-based training for line insertions, standardised and real-time bundle monitoring by direct observations are key interventions tested. We used model for improvement and changes were tested using small Plan-Do-Study-Act cycles. Surveillance methods and CLABSI definition used according to National Healthcare Safety Network.Results The CLABSI rate per 1000 patient-days dropped from 3.1 per 1000 device-days to 0.4 per 1000 device-days. We achieved 757 days free of CLABSI in the unit till December 2018 when a single case happened. After that we achieved 602 free days till July 2020 and still counting.Conclusions Implementation of evidence-based CLABSI prevention bundle and process monitoring by direct observation led to significant and subsequently sustained improvement in reducing CLABSI rate in adult CICU.