Enhancing central-line-associated bloodstream infection prevention: evaluating enhanced strategies in an academic medical centre in Singapore.

BACKGROUND

Whilst insertion and maintenance bundles serve as essential preventive measures for central line-associated bloodstream infections (CLABSIs), the efficacy of enhanced strategies such as chlorhexidine-impregnated dressings and alcohol-impregnated port protectors remains relatively unexplored on a hospital-wide scale. This study evaluates the impact of implementing 2% chlorhexidine gluconate-impregnated (CHG) dressings and 70% isopropyl alcohol-impregnated (IPA) port protectors in reducing CLABSI risks across a 1900-bed academic medical centre in Singapore.

METHODS

Singapore General Hospital introduced CHG dressings in July 2020 and expanded their use hospital wide in January 2021. Additionally, IPA port protectors were implemented hospital wide in September 2021. The incidence rates of CLABSI per 1000 central line (CL)-days were monitored to evaluate outcomes.

RESULTS

From November 2017 to January 2020 (baseline period), the CLABSI incidence rate was 0.81 per 1000 CL-days. For the period February 2021 to September 2021, prior to the implementation of IPA port protectors, the rate decreased to 0.53 per 1000 CL-days (incidence rate ratio (IRR) 0.61 (95% confidence interval (CI) 0.37-0.98); P=0.073). The rate further declined to 0.45 per 1000 CL-days from October 2021 to December 2024 (post-implementation of both strategies), representing a statistically significant reduction (IRR 0.53 (95% CI 0.40-0.71); P<0.001). The combined strategy of CHG dressings and IPA port protectors potentially reduced the risk of CLABSIs by 47%.

CONCLUSION

Our experience demonstrated a statistically significant reduction in CLABSI rates following the 3-year implementation of CHG dressings and IPA port protectors as part of routine hospital-wide preventive measures against CLABSI.