5.3/1000 CVC‐days for HHi, CVCi and COMBi, respectively. Figure 2 shows the quarterly CRBSI incidence density for each study arm (results for each center in Supp. Fig. 2). Table 2 shows the results of the univariable and multivariable regression analyses. CRBSI incidence density reduction between baseline and intervention was significant in all study arms, when adjusted in the multivariable regression analysis: the sub‐distribution hazard ratios (HRsub; 95% CI) for the CVCi‐, HHi‐, and COMBi arms were 0.59 (0.43–0.81), 0.46 (0.28–0.74), and 0.33 (0.24–0.47), respectively. CRBSI incidence density tended to decrease already during baseline (HRsub 0.93; [0.84 – 1.02], per baseline quarter). When adjusting for possible underlying hospital‐ specific trends and taking into account an intervention‐specific trend, CRBSI reduction remained significant in the HHi‐ and COMBi arms: HRsub 0.37 (0.16–0.87) and 0.47 (0.27– 0.83), respectively. In this model, CRBSI reduction was not significant in the CVCi arm: HRsub 1.16 (0.63–2.16). The interventions did not result in significant changes of the baseline trends (Supp. Methods and results). The overall median CVC dwell‐time until infection was prolonged from 10 to 11.5 days (p=0.042). Microorganisms The overall distribution of isolated microorganisms was as follows: Gram negative organisms: 44.0%; Gram positive organisms: 41.6%; Candida spp. 6.8%; and multiple organisms: 7.6%. The most frequent species were Acinetobacter baumannii (17.3%), Staphylococus epidermidis (15.7%), other coagulase negative staphylococci (CoNS) (14.1%), Klebsiella pneumoniae (9.7%), Pseudomonas aeruginosa (9.2%), Staphylococcus aureus (8.4%), Candida spp. (7.9%), Enterococcus faecium (4.7%), and E. faecalis (4.5%). CRBSI‐reduction was significant for Acinetobacter baumannii (HRsub 0.39 [0.23‐0.67]), Staphylococcus epidermidis (0.33 [0.19‐0.56]), Pseudomonas aeruginosa (0.39 [0.18‐ 0.83]) and CoNS other than S. epidermidis (0.04 [0.01‐0.20]). CVC insertion score A total of 3,572 CVC insertions were observed, i.e. 8.9% (IQR 6.4 – 15.6%) of all study CVCs. Supp. Table 5 shows the results for each insertion score element. CVC insertion scores improved in all study arms (Fig. 2, individual hospitals in Supp. Fig. 3): between baseline and intervention period, the mean insertion scores in the CVCi‐, HHi‐ and COMBi arms improved from 69% to 92% (OR [95%CI]: 4.0 [3.7–4.4]; p<0.0001), from 66% to 85%
RkJQdWJsaXNoZXIy MTk4NDMw