Quality Problem: The incidence of central line-associated bloodstream infections (CLABSI) in Latin America has been estimated at 4.9 episodes per 1000 central line (CL) days, compared to a pooled incidence of 0.9 in the United States. CLABSI usually result from not adhering to standardized health procedures and can be prevented using evidence-based practices. Initial Assessment: The first phase of the 'Adiós Bacteriemias' Collaborative was implemented in 39 intensive care units (ICUs) from Latin America from September 2012 to September 2013 with a 56% overall reduction in the incidence of CLABSI. Choice of Solution: Bundles of care for the processes of insertion and maintenance of CLs have proven to be effective in the reduction of CLABSI across different settings. Implementation: Building on the results of the first phase, we implemented a second phase of the 'Adiós Bacteriemias' Collaborative between June 2014-July 2015. We adapted the Breakthrough Series (BTS) Collaborative model to guide the adoption of bundles of care for CLABSI prevention through virtual learning sessions and continuous feedback. Evaluation: Eighty-three ICUs from five Latin American countries actively reported process and outcome measures. The overall reduction in the CLABSI incidence rate was 22% (incidence rate 0.78; 95% CI 0.65, 0.95), from 2.58 episodes per 1000 CL days at baseline to 2.02 episodes per 1000 CL days (P < 0.01) during the intervention period. Lessons Learned: Adiós Bacteriemias was effective in reducing the incidence of CLABSI and improving the adherence to good practices for CL insertion and maintenance processes in participating ICUs in Latin America.

This study shows that the APSQ-III modified survey is valid and could be used in Argentina and the region to measure the impact of incorporating patient safety topics in the medical curriculum.

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BackgroundCentral line-associated bloodstream infections (CLABSI) are the leading cause of healthcare-associated bloodstream infections, prolonging hospitalizations, and increasing healthcare costs, morbidity and mortality. The CLABSI incidence for Latin America has been estimated at 7.6 episodes per 1,000 central line days. In developing countries, CLABSI are usually the result of failing to follow evidence-based practices.ObjectivesThe ‘Goodbye Bacteremia' collaborative aimed at reducing the CLABSI incidence by 50% or to less than 2 episodes per 1,000 central line days from baseline within 12 months of the implementation of the collaborative.Methods Design: Uncontrolled before-and-after CLABSI rates comparison. Setting: 83 ICUs from 32 hospitals from five Latin American countries.Intervention: We used a quality-improvement collaborative to promote the adoption of bundles of care for the insertion and maintenance of central lines, coupled with education through virtual bi-weekly learning sessions, from June 2014 to June 2015.Measures: Self-reported CLABSI incidence; percentage compliance with central line insertion bundle; percentage compliance with central line maintenance bundle.ResultsThe overall reduction on the CLABSI incidence was 26% (incidence rate [IR], 0.78; 95% CI 0.61, 0.92) from 2.58 episodes per 1,000 central line days at baseline to 2.02 episodes per 1,000 central line days (p<0.01) during the collaborative. The average percentage compliance increased from 67.8% at baseline to 86.0% for the insertion bundle, and from 82.3% at baseline to 90.9% at the end of the collaborative for the maintenance bundle.ConclusionsEvidence-based interventions and multi-country collaborative work contributed to a significant reduction in the incidence of CLABSI in Latin American ICUs.Figure 1Figure 2Figure 3