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Infection, prevention and control excellence in the Kingdom of Saudi Arabia: reducing central line-associated bloodstream infections [1]

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Date: 2024-11

In 2021, the Kingdom of Saudi Arabia (Saudi Arabia) faced a significant public health challenge: Central line-associated bloodstream infections (CLABSI) were alarmingly prevalent, particularly in adult intensive care units (ICUs). Through a comprehensive initiative led by the Ministry of Health and involving facility managers and clinicians Saudi Arabia has seen a reduction of 48.8% in the occurrence of CLABSI compared to 2021.

The initiative: strategic actions for change

Poor practice in the insertion, maintenance and removal of central catheters can result in germs being introduced to a patient’s bloodstream, leading to infection. CLABSI can lead to severe sepsis, partly because people who receive treatment from catheters are often already ill and therefore particularly vulnerable to infection. This not only causes harm and suffering to patients but also increases health care costs and prolongs hospital stays. Recognizing the urgent need for action, the Ministry of Health (MoH) decided to spearhead a national initiative to tackle the issue.

Launching the initiative

In 2022, the MoH, in collaboration with various stakeholders including the General Directorate of Infection Prevention and Control (GDIPC), Public Health Authority (Weqaya), and the Ministry of Defence Health Services, launched a comprehensive initiative. The objective was to reduce CLABSI rates in all hospitals with adult medical and surgical ICUs, encompassing both public and private facilities.

Strategic planning and implementation

A task force was established to guide the initiative, including active participation from all levels, from the MOH, the regional health authorities and infection prevention and control (IPC) professionals and clinicians from the involved facilities. Initial assessments of CLABSI rates nationwide revealed critical areas needing immediate attention. Further detailed analysis identified two critical underlying factors contributing to high CLABSI rate: lack of attention to the problem and poor practice in insertion, maintenance and removal.

Based on these findings, a strategic plan was developed, encompassing several key components:

Governance: Regional health branches were mandated to implement the initiative, with central oversight by the GDIPC.

Regional health branches were mandated to implement the initiative, with central oversight by the GDIPC. Surveillance: A national electronic platform was employed to monitor CLABSI rates and trends in real-time.

A national electronic platform was employed to monitor CLABSI rates and trends in real-time. Guidelines and Tools: Evidence-based guidelines for central line insertion and maintenance were developed, along with necessary implementation tools.

Evidence-based guidelines for central line insertion and maintenance were developed, along with necessary implementation tools. System Change: Ensuring the availability of essential supplies and infrastructure was prioritized.

Ensuring the availability of essential supplies and infrastructure was prioritized. Education and Training: Hybrid training programmes were conducted for health care providers, enhancing their knowledge and skills in CLABSI prevention.

Hybrid training programmes were conducted for health care providers, enhancing their knowledge and skills in CLABSI prevention. Competition for Excellence: The “Go Green” competition encouraged hospitals to reduce CLABSI rates, fostering a culture of excellence.

The “Go Green” competition encouraged hospitals to reduce CLABSI rates, fostering a culture of excellence. Monitoring and Evaluation: Regular data analysis and reporting were conducted to track progress and identify areas for improvement.

The impact: significant achievements

The initiative yielded remarkable results. The average infection rate dropped from 2.5 per 1000 days that patients had central catheters in 2021 to 1.28 per 1 000 central catheter days by the third quarter of 2024. Additionally, other health care-associated infection rates also declined, reflecting, in part, the influence of the initiative in improving infection prevention and control measures overall.

Overall, 222 health care facilities have benefitted from the initiative. Nearly 5000 healthcare providers were trained, resulting in a 98% compliance rate with the central line maintenance bundle in 2024.

Ongoing efforts and future plans

Saudi Arabia’s national initiative to reduce CLABSI rates stands as a testament to the power of strategic planning, collaboration, and the implementation of best practices. The engagement and leadership role of governmental authorities, active participation from all stakeholders including clinicians, use of data for decision making, and the implementation of a multimodal strategy has been key to initiative’s success.

The initiative is ongoing, with continuous efforts to sustain and further improve CLABSI rates. Regular training and competency assessments are conducted to maintain high standards of IPC practices. The surveillance system is regularly updated to ensure accurate data collection and analysis. Feedback from healthcare providers is gathered to identify barriers and opportunities for further improvement. Future plans include expanding the initiative to cover more healthcare facilities and integrating new technologies to enhance surveillance and data analysis.

This project is led by the Ministry of Health’s General Directorate of Infection Prevention and Control.

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[1] Url: https://www.who.int/news-room/feature-stories/detail/infection--prevention-and-control-excellence-in-the-kingdom-of-saudi-arabia--reducing-central-line-associated-bloodstream-infections

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