INTRODUCTION Central venous catheters (CVCs) are an important cause of bloodstream infections. These infections increase the length of hospital stay and medical costs [1, 2]. Dutch hospitals can participate in surveillance of central venous catheter‐related bloodstream infections (CRBSI) within the national surveillance network for healthcare associated infections (PREZIES). Between 2002 and 2009 the average CRBSI incidence density in nine hospitals was 2.0/1 000 CVC days [3, 4]. There was large variation in CRBSI incidence between hospitals (range 0.9 to 3.0) and the impression was that rates were higher in hospitals that did not participate, suggesting that improvement was still possible [3]. In 2008, the Dutch Hospital Patient Safety Programme (DHPSP) was initiated to prevent adverse events and avoidable deaths in hospitalized patients [5]. One of the 10 subprogrammes included CRBSI prevention, with the goal to decrease the incidence of CRBSI to less than 3 cases per 1000 CVC days in all hospitals. To achieve this a six‐item intervention bundle was introduced (Box 1), based on the successful bundle of Pronovost et al[6]. Hospital staff from infection control, quality control and intensive care departments attended national workshops, where the scientific background, implementation and surveillance of the CRBSI prevention tool was discussed. The DHPSP additionally supplied campaign material and tools to use in the hospitals. The DHPSP was initially planned to run until 2013, but was extended for a further two years, with the aim that hospitals should achieve 90% compliance with the bundle. It was expected that increased bundle compliance would result in decreased CRBSI rates. Dutch hospitals were advised to implement the intervention bundle for all CVCs and to report compliance and outcomes within the national surveillance network. Registration of the bundle compliance was facilitated until 2019. The goal of this study was to determine the impact of the intervention bundle on the CRBSI risk in the Netherlands. METHODS CRBSI surveillance Participation in the Dutch national surveillance network is voluntarily. The incidence of CRBSI is assessed using strict criteria based on the definitions from the (European) Centre for Disease Control (Supplementary Textbox A1). Participating hospitals report data on all non‐tunnelled CVCs of patients of ≥18 years, inserted for ≥48 hours in the subclavian, jugular, or femoral vein. The maximum duration of follow‐up of the CVC is 28 days, but follow‐up (including bundle compliance monitoring) ends in the event of a CRBSI, CVC removal, discharge, death or when treatment is discontinued due to impending death. A new hospital admission is considered a new patient. Patient characteristics (sex, date of 9 217 The effect of a CRBSI prevention bundle in the Netherlands
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