Stepwise introduction of the 'Best Care Always' central-line-associated bloodstream infection prevention bundle in a network of South African hospitals

Background: Healthcare-associated infection (HCAI) remains a major international problem. Aim: The 'Best Care Always!' (BCA) campaign was launched in South Africa to reduce preventable HCAI, including central-line-associated bloodstream infection (CLABSI). Methods: The intervention took place in 43 Netcare Private Hospitals, increasing later to 49 with 958 intensive care units (ICUs) and 439 high-care (HC) beds and 1207 ICUs and 493 HC beds, respectively. Phase 1, April 2010 to March 2011, ICU infection prevention and control (IPC) nurse-driven change: commitment from management and doctors and training of IPC nurses. Bundle compliance and infections per 1000 central-line-days were incorporated as standard IPC measures and captured monthly. Phase 2, April 2011 to March 2012, breakthrough collaborative method: multiple regional learning sessions for nursing leaders, IPC nurses and unit managers. Phase 3, April 2012 to May 2016: sustained goal-setting, benchmarks, ongoing audits. Findings: A total of 1,119,558 central-line-days were recorded. Bundle compliance improved significantly from a mean of 73.1% [standard deviation (SD): 11.2; range: 40.6 -81.7%] in Phase 1 to a mean of 90.5% (SD: 4.7; range: 76.5-97.2%) in Phase 3 (P = 0.0004). The CLABSI rate declined significantly from a mean of 3.55 (SD: 0.82; range: 2.54-5.78) per 1000 central-line-days in Phase 1 to a mean of 0.13 (SD: 0.09; range: 0 e0.33) (P < 0.0001). Conclusion: This intervention, the first of its kind in South Africa, through considerable motivation and education, and through competition between hospitals resulted in significant decreases in CLABSI. (C) 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.