@article{5042,
  author = {Mercedes Palomar and Francisco Álvarez-Lerma and Alba Riera and María Teresa Díaz and Ferrán Torres and Yolanda Agra and Itziar Larizgoitia and Christine A. Goeschel and Peter Pronovost and Bacteremia Zero Working Group},
  title = {Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience.},
  abstract = {<p><b>OBJECTIVE: </b>Prevention of catheter-related bloodstream infection is a basic objective to optimize patient safety in the ICU. Building on the early success of a patient safety unit-based comprehensive intervention (the Keystone ICU project in Michigan), the Bacteremia Zero project aimed to assess its effectiveness after contextual adaptation at large-scale implementation in Spanish ICUs.</p><p><b>DESIGN: </b>Prospective time series.</p><p><b>SETTING: </b>A total of 192 ICUs throughout Spain.</p><p><b>PATIENTS: </b>All patients admitted to the participating ICUs during the study period (baseline April 1 to June 30, 2008; intervention period from January 1, 2009, to June 30, 2010).</p><p><b>INTERVENTION: </b>Engagement, education, execution, and evaluation were key program features. Main components of the intervention included a bundle of evidence-based clinical practices during insertion and maintenance of catheters and a unit-based safety program (including patient safety training and identification and analysis of errors through patient safety rounds) to improve the safety culture.</p><p><b>MEASUREMENTS AND MAIN RESULTS: </b>The number of catheter-related bloodstream infections was expressed as median and interquartile range. Poisson distribution was used to calculate incidence rates and risk estimates. The participating ICUs accounted for 68% of all ICUs in Spain. Catheter-related bloodstream infection was reduced after 16-18 months of participation (median 3.07 vs 1.12 episodes per 1,000 catheter-days, p<0.001). The adjusted incidence rate of bacteremia showed a 50% risk reduction (95% CI, 0.39-0.63) at the end of the follow-up period compared with baseline. The reduction was independent of hospital size and type.</p><p><b>CONCLUSIONS: </b>Results of the Bacteremia Zero project confirmed that the intervention significantly reduced catheter-related bloodstream infection after large-scale implementation in Spanish ICUs. This study suggests that the intervention can also be effective in different socioeconomic contexts even with decentralized health systems.</p>},
  year = {2013},
  journal = {Crit Care Med},
  volume = {41},
  pages = {2364-72},
  month = {10/2013},
  issn = {1530-0293},
  doi = {10.1097/CCM.0b013e3182923622},
  language = {eng},
}