QAPI 101 - Central Line-associated Bloodstream Infection (CLABSI) Prevention Strategy in Patients Undergoing Hematopoietic Stem Cell Transplant (HSCT) in Tertiary Hospital in Brazil

Background: Healthcare-acquired infections (HAI) in patients undergoing hematopoietic stem cell transplant (HSCT) are associated with an increased risk of mortality. Increased risks are attributed, in part, to immunosuppression, neutropenia and prolonged use of central line. During epidemiological surveillance of the infection control service (ICS) in a HSCT unit in a tertiary hospital in Brazil showed that Central Line-associated Bloodstream infection (CLABSI) was the most prevalent device-associated infection. The objective of this study is to show the strategy adopted in HSCT unit to reduce CLABSI.

Methods: This prospective study included all patients hospitalized in a HSCT unit. The strategy have been implemented gradually between January and July 2021. All actions were coordinated by ICS and the HSCT unit nursing leader. The actions focused on patient guidance on CLABSI prevention: hand hygiene, dressing care and use of antiseptic-containing protector cap to cover connectors. Infection prevention bundle applied weekly by infection control nurse and nursing leader. Unit leadership's weekly huddle with their team to Feedback about patient perteptions and bundle opportunities. Notified and discussion of CLABIS ocurred in a multidisciplinary meeting.

Results: Despite still being the most prevalent infection, between July 2020 and December 2020, the patients undergoing HSCT surveillance has found 5 CLABSI episodes in two thousand five hundred and fifty patient-days, resulting in a HAI rate of 1,96 per 1,000 patient-days. Betwen July 2021 and December 2021, the patients undergoing HSCT surveillance has found 1 CLABSI episode in one thousand and fifty one patient-days, resulting in a HAI rate of 0,95 per 1,000 patient-days. In January 2022, the infection control service began to monitor the CLABSI in TCTH patients using as a denominator the central line-day of patients in this unit undergoing the TCTH.

Conclusions: Infection prevention strategies involving family members, leaders and a multidisciplinary team result in a reduction of HAI.