Sustained Reduction of Central Line–associated Primary Bloodstream Infection: Is It Achievable?

Central venous catheter–associated bloodstream infection (CLABSI) is a frequent complication in hospitalized patients, associated with increased morbidity, mortality, and costs. Preventing and controlling this infection is essential to ensure patient safety and improve quality of healthcare. In the 2021–2023 triennium, the institution enrolled in a Ministry of Health project – Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde (PROADI-SUS) – aiming to support projects that improve management, care, and health promotion, reducing healthcare-associated infections. The institution succeeded in implementing some actions, such as: (1) incorporation of the Kamishibai visual audit tool to monitor adherence to prevention practices and allow regular, objective evaluation of healthcare professionals, identifying opportunities for improvement; (2) use of PDSA (Plan-Do-Study-Act) to test changes and allow the team to plan, implement, evaluate, and adjust changes continuously; (3) implementation of Bundles for Medication Administration and Hemodialysis Installation and Removal, to ensure professionals followed recommended procedures during these CVC manipulation steps; (4) standardized prescription of venous catheter care, to ensure staff followed best practices in caring for venous catheters; (5) incorporation of new technologies: closed-system connectors for hemodialysis catheters and antimicrobial-impregnated catheters; (6) monthly discussions with sectors about identified improvement opportunities. Sustained reduction of CLABSI is feasible with integration of multiple preventive strategies. A safety culture, leadership, continuing education, and rational use of technology are fundamental. Results depend more on structure and process than only innovation. With implementation of these changes, we achieved a relative risk reduction of 46. 5%, but without statistical significance in applied tests—possibly due to the small sample size. Even so, the trend suggests clinical benefit. In addition, we had an average aggregated reduction of hospital costs of R 1, 221, 373. 37, resulting from a total of 23 CLABSIs prevented.