EVALUATION OF A PROGRAM TO CONTROL CATHETER-RELATED BLOODSTREAM INFECTIONS AT A TERTIARY INSTITUTION IN MALAYSIA

Central venous catheters (CVCs) may increase the risk of catheterrelated bloodstream infections (CRBSI). In this study, we aimed to determine the efficacy of a program to reduce CRBSI at the Universiti Sains Malaysia Hospital in Kelantan Malaysia to determine the program's potential for application to other hospitals in Malaysia. The intervention program was developed following the United States Centers for Disease Control and Prevention guidelines, and the implementation was started in January 2017. We retrospectively reviewed the medical records of all admitted patients aged >18 years with a CVC placed before the intervention program (admitted during April-December 2016) and after initiation of the intervention program (admitted during April-December 2017). The incidences of CRBSI, etiological organisms and antimicrobials used to treat subjects during the two study periods were compared. Prior to the intervention, 1037 patients had a CVC placed at the study institution of whom 72 (6.94%) developed a CRBSI. After the intervention, 925 patients had a CVC placed of whom 54 (5.83%) developed a CRBSI. There was no significant decrease in the incidence of CRBSI after the intervention (odds ratio = 0.83, 95% confidence interval: 0.58-1.20; p = 0.319). Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), was the most common Gram-positive organism isolated during the pre-intervention (33.3%, n = 24) and post-intervention (22.2%, n = 12) periods. Klebsiella pneumoniae, including the ESBL strain, was the most common Gram-negative organism isolated during the pre-intervention (7%, n = 5) and post-intervention (9.3%, n = 5) periods. Cloxacillin was the commonest antibiotic used during the pre-intervention period and ceftazidime was the most common antibiotic used during the post-intervention period. In summary, the intervention did not significantly reduce the incidence of CRBSI among study subjects but there appeared to be a slightly change in etiological organisms after the intervention. We conclude the intervention was not effective. Further studies are needed to determine the reason for the failure of the intervention and to determine why there appears to have been a change in the etiological organisms post-intervention.