Impact of intensified prevention measures on rates of hospital-acquired bloodstream infection in medical- surgical intensive care units, Israel, 2011 to 2019

Background: Central line-associated bloodstream infection (CLABSI) is among the most common pre-ventable infectious complications in patients in inten-sive care units (ICU). In 2011, the Israel National Center for Infection Control initiated a nationwide CLABSI pre-vention programme.Aim: To evaluate the impact of different components of the programme on CLABSI and non-CLABSI rates in medical-surgical ICUs.Methods: We included data collected from all 29 medical-surgical ICUs in Israel from November 2011 to December 2019. The study period was divided into three phases: I (baseline, initial CLABSI preven-tion guidelines introduced, initial feedback on rates provided), II (initial guidelines widely implemented, surveillance undertaken, feedback continued) and III (after implementation of additional prevention meas-ures). Interrupted time series analysis was used to compare CLABSI and non-CLABSI rates during the three phases.Results: The pooled mean (SD) incidence of CLABSI per 1,000 central line-days dropped from 7.4 (0.38) in phase I to 2.1 (0.13) in phase III (p < 0.001). The inci-dence rate ratio (IRR) was 0.63 (95% CI: 0.51-0.79) between phases I and II, and 0.78 (95% CI: 0.59-1.02) between phases II and III. The pooled mean (SD) inci-dence of non-CLABSI per 1,000 patient-days declined from 5.3 (0.24) in phase I to 3.4 (0.13) in phase III (p < 0.001).Conclusion: National CLABSI prevention guidelines, surveillance and feedback resulted in significant reductions in CLABSI and non-CLABSI rates. In the wake of further interventions, significant reduction was achieved in ICUs reporting improvement in the uptake of additional prevention measures.