8-275 / Bacteriemia zero Programme

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
Ministry of Health, Social Services and Equality, Spain


Patient safety system
Quality improvement project
Handling of catheters
Implementation of Patient Safety initiatives / Activities
GOP Description
Implementation level
Clinical settings
Intensive Care Units (ICU)
-Reduction of Catheter-related bloodstream infection (CRBSI) <4 CRBSIs per 1000 central venous catheter (CVC) days
-To promote PS culture in the ICU
-To promote the implementation of patient safety evidence based practices in the ICU
All patients admitted to the participating ICUs
All adult ICUs from the 17 Health Regions from the NHS are invited to participate
Based in the keystone-project lead by Pronovost in USA
Prospective cohort study design including three phases:
-Plannificaction: adaptation of materials, organization, selection of coordinators at regional and hospital level, engagement of ICUs, baseline data collection. April-Dec-2008
-Implementation: project adaptation to the ICU. Jan-March-2009
-Intervention: April-2009 to Dec 2012 up today
The programme includes two types of intervention
1.STOP-CRBSI (evidenced-based-procedures):
.Hand hygiene
. full-barrier-precautions during the insertion
. cleaning-skin with chlorhexiding
.avoiding femoral-site
. removing unnecessary catheters
. proper catheter maintenance
Professional-perception of PS-culture (Spanish version of the Hospital Survey on Patient Safety)
.PS training
.Learning from errors
.Alliance with managersProgramme organization
-National-coordination team: SEMICYUC, SMoH, WHO
-Regional-coordination-team: regional-representative, MD&nurse-intensivist; and preventivist
-Local-coordination-team: MD&nurse; in each participant ICU Coordinated and supervised operations at every unit, and across units in the health region was stated.
Data registered are reviewed by SEMICYUC every 3 month to control information errors-ENVIN-HELICS data based: http://hws.vhebron.net/envin-helics
(National Surveillance Program of ICU-Acquired Infection)

-Registry of safety indicators: http://hws.vhebron.net/bacteriemia-zero/ (referring to: chlorhexidine skin antisepsis, check-list for catheter insertion, central-line cart, daily goals, learning from errors, and safety rounds)
-Web-learning-platform provided by WHO: http://ezcollab.who.int/

Definitions: European surveillance program for nosocomial infections

Timeframe implementation
18 months (including translation-adaptation of the material) to show a reduction rate of 50%
Implementation tools available
-Online course (including STOP-CRBSI and PS module)
-Posters and video
– Spanish version of the Hospital Survey on Patient Safety
-Specific tools: Daily goals; Checklist; Walk rounds; Learning from errors framework
-Support documents (protocol, guides)
Implementation cost
Funds for Health Regions: 1.942.650,72 €
Technical management: 341.178 €
11 Project Meetings: 62.578,68 €
On line platform and database: 7.505 €
Method used to measure the results
-Method used to measure the results
The local team registers monthly the number of patients, patient-days, and catheter-days (patients with one or more central venous catheter: CVC) at each ICU.
.CRBSI, patient’s age and gender, APACHE II score, length of ICU stay, mortality, ICU and hospital characteristics, and length of follow up
220 ICU participating (variation over time)
More than 15.000 professionals trained online
80% of ICU participate in the programme
CRBSI was reduced from 4, 9 episodes per 1000 catheter-days to 2, 8 in 2010, 2,6 in 2011 and 2,2 in 2012 (global mean per year) (p<0.001). The adjusted incidence rate of bacteremia was > 50% risk reduction.. During 2009-2012, 265 death were avoided as well as 35.376 stay-days
–     Savings for the NHS: 109.771.728 € (3.103 €/ICU-stay-days during 2010) during 2009-2012 period
Analysis of the results
-The number of CRBSI, catheter-days, and incidence rates were expressed as medians and interquartile ranges (25th-75th percentile) and mean incident rates.
Generalized linear mixed regression models with a Poisson distribution (18) to calculate the incidence rates, incidence rate ratio (IRR), and 95% confidence intervals (CI), was used
-Data about scores changes in the perception questionnaire not available yet
-Interviews and focus groups were performed to analysed the perception of professionals (data under analysis)
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
.Resistance to accept the project and the needed tools, mainly the PS interventions
.Some budget did not reach the ICU participants
.Resources restrictions
Describe the strategies used to overcome the barriers (If needed)
.Continuous contact between coordinator teams
.Two meetings every year to present the results (aggregated and by HR), problems detected and improvement proposals
.Adaptation of tools if needed (“daily goals”,etc)
.Letters to the hospital managers to support the project
.Promoting leadership.
Other information
Other information about the GOP that you would like to add (Link or attached document)
http://www.who.int/patientsafety/implementation/bsi/bacteriemia_zero/en/index.html-Mercedes Palomar, M.D., Ph.D, Francisco Álvarez-Lerma, M.D., Ph.D., Alba Riera, RN., María Teresa Díaz RN (†), Ferrán Torres, M.D., Ph.D., Yolanda Agra M.D. Ph.D, Itziar Larizgoitia, M.D., M.P.H., Ph.D., Christine A. Goeschel, Sc.D., M.P.A, M.P.S., R.N., Peter J. Pronovost, M.D., Ph.D., on behalf of the Bacteremia Zero Working Group. Impact of a National Multimodal Intervention to Prevent Catheter-Related Bloodstream Infection in the ICU: The Spanish Experience. (Critical Care Med, in press)