Control of vascular access device associated bloodstream infection in a large London teaching hospital

Abstract

We describe a quality improvement programme used in a large teaching hospital trust to reduce the number of hospital acquired blood stream infections (HA-BSI) relating to vascular devices. Our strategy included the appointment of a lead nurse whose role was to engage with clinicians, to develop guidelines, to standardise and facilitate good practice, to train to uniform standards, and to retain local ownership, while working to avoid risk compensation. Information was gathered using our laboratory data search system, as well as observation and audit of vascular access device practice. Vascular access device training became part of all induction and update programmes for clinical staff.The results showed a significant and sustained decline in frequency of patient episodes of HA-BSI. The numbers of patients from whom coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Klebsiella and Enterobacter spp. were isolated in any given month all declined significantly. The numbers of patients with positive blood cultures with Escherichia coli did not decline. The improvement has been sustained for more than 3.5 years. This study shows that when standardisation, facilitation and education are developed with stakeholder involvement, it is possible to achieve a sustained reduction in the incidence of vascular device associated infections.