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Lv Y, Huang X, Xiang Q, Yang Q, Chen J, Cai M, Wang P, Jia P, Wang H, Xie C, Li L, Zhang D, Wei D, Wu J. Effectiveness of enhanced check during acute phase to reduce central venous catheters-associated bloodstream infections: a before-after, real-world study. Antimicrob Resist Infect Control 2022; 11:151. [PMID: 36474305 PMCID: PMC9724293 DOI: 10.1186/s13756-022-01190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of enhanced check to the duration of the central venous catheters associated bloodstream infections (CABSIs), and the impact on infection rates. METHODS A before-after, real-world study in six adult intensive care units was conducted. All adult patients who had only one central venous catheter were included during two consecutive periods. The intervention period, added cross-check that all patients with central venous catheter (CVC) need to be performed, and included nurses' checks for insertion practices and doctors' checks for maintenance practices. Propensity scores matching were used to account for potential confounding, and restricted cubic spline was served as visualizing the CABSI risk. RESULTS A total of 2906 patients with 26,157 CVC-days were analyzed. After intervention, the density incidence of CABSI decreased from 10.24 to 6.33/1,000 CVC-days (P < 0.001), and the acute period of rapid increase in CABSI risk was shortened, 6.5 to 5 days for femoral-vein catheterization and 7 to 5.5 days for subclavian-vein catheterization. For jugular-vein catheterization, the acute onset period disappeared. CONCLUSION Enhanced check during the first 7 calendar days after CVC insertion shortens the duration of the CABSI acute phase and tends to decrease CABSI rate.
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Affiliation(s)
- Yu Lv
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Xiaobo Huang
- grid.54549.390000 0004 0369 4060Intensive Care Unit, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Qian Xiang
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Qin Yang
- grid.54549.390000 0004 0369 4060Department of Nursing, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Jin Chen
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Minhong Cai
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Pingping Wang
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Ping Jia
- grid.54549.390000 0004 0369 4060Intensive Care Unit, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Hui Wang
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Caixia Xie
- grid.54549.390000 0004 0369 4060Department of Nursing, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Luting Li
- Development Department, Chengdu Yiou Technology Co. LTD, Chengdu, 610000 Sichuan People’s Republic of China
| | - Dingding Zhang
- grid.54549.390000 0004 0369 4060Sichuan Provincial Key Laboratory for Disease Gene Study, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Daoqiong Wei
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
| | - Jiayu Wu
- grid.54549.390000 0004 0369 4060Healthcare-Associated Infection Control Center, Sichuan Academy of Medical Sciences, Sichuan People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072 Sichuan People’s Republic of China
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Poh KW, Ngan CH, Wong JY, Ng TK, Mohd Noor N. Reduction of central-line-associated bloodstream infection (CLABSI) in resource limited, nonintensive care unit (ICU) settings. Int J Health Care Qual Assur 2021; ahead-of-print. [PMID: 32108452 DOI: 10.1108/ijhcqa-11-2019-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE There was limited study available on successful intervention for central-line-associated bloodstream infection (CLABSI) done at nonintensive care unit (ICU) and resources-limited setting. The objective of this study was to design, implement and evaluate a strategy to reduce CLABSI rate in non-ICU settings at general medical wards of Hospital Tuanku Ja'afar Seremban. DESIGN/METHODOLOGY/APPROACH Preinterventional study was conducted in one-month period of January 2019, followed by intervention period from February to March 2019. Postintervention study was conducted from April to July 2019. The CLABSI rates were compared between pre and postintervention periods. A multifaceted intervention bundle was implemented, which comprised (1) educational program for healthcare workers, (2) weekly audit and feedback and (3) implementation of central line bundle of care. FINDINGS There was a significant overall reduction of CLABSI rate between preintervention and postintervention period [incidence rate ratio (IRR) of 0.06 (95 percent CI, 0.01-0.33; P = 0.001)]. PRACTICAL IMPLICATIONS CLABSI rates were reduced by a multifaceted intervention bundle, even in non-ICU and resource-limited setting. This includes a preinterventional study to identify the risk factors followed by a local adaption of the recommended care bundles. This study recommends resources-limited hospitals to design a strategy that is suitable for their own local setting to reduce CLABSI. ORIGINALITY/VALUE This study demonstrated the feasibility of a multifaceted intervention bundle that was locally adapted with an evidence-based approach to reduce CLABSI rate in non-ICU and resource-limited setting.
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Affiliation(s)
- Kok Wei Poh
- Medical, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | | | - Ji Yin Wong
- Medical, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
| | - Tiang Koi Ng
- Medical, Hospital Tuanku Ja'afar Seremban, Seremban, Malaysia
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Patel PK, Gupta A, Vaughn VM, Mann JD, Ameling JM, Meddings J. Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. J Hosp Med 2018; 13:105-116. [PMID: 29154382 DOI: 10.12788/jhm.2856] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) are costly and morbid. Despite evidence-based guidelines, Some intensive care units (ICUs) continue to have elevated infection rates. In October 2015, we performed a systematic search of the peer-reviewed literature within the PubMed and Cochrane databases for interventions to reduce CLABSI and/or CAUTI in adult ICUs and synthesized findings using a narrative review process. The interventions were categorized using a conceptual model, with stages applicable to both CAUTI and CLABSI prevention: (stage 0) avoid catheter if possible, (stage 1) ensure aseptic placement, (stage 2) maintain awareness and proper care of catheters in place, and (stage 3) promptly remove unnecessary catheters. We also looked for effective components that the 5 most successful (by reduction in infection rates) studies of each infection shared. Interventions that addressed multiple stages within the conceptual model were common in these successful studies. Assuring compliance with infection prevention efforts via auditing and timely feedback were also common. Hospitalists with patient safety interests may find this review informative for formulating quality improvement interventions to reduce these infections.
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Affiliation(s)
- Payal K Patel
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA.
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Valerie M Vaughn
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jason D Mann
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jessica M Ameling
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Meddings
- Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Pediatrics and Communicable Diseases, Division of General Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
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Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Martín-Rabadán P, Bouza E. Nationwide study on peripheral-venous-catheter-associated-bloodstream infections in internal medicine departments. J Hosp Infect 2017; 97:260-266. [PMID: 28716670 DOI: 10.1016/j.jhin.2017.07.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/04/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND The use of peripheral venous catheters (PVCs) has increased outside intensive care units, as has the rate of PVC-associated-bloodstream infection (PVC-BSI). PVCs are widely used in internal medicine departments (IMDs), but data on the incidence of PVC-BSI and its characteristics in IMDs are scarce. AIM To assess the incidence of PVC-BSI episodes detected in IMDs in Spain. METHODS A one-year multi-centre prospective observational cohort study in 14 Spanish IMDs was undertaken. Adult patients admitted with at least one PVC and bacteraemia were included in the study. Demographic and clinical data were provided by local coordinators. FINDINGS Seventy episodes of PVC-BSI were recorded, representing an overall rate of 1.64 PVC-BSI episodes/1000 IMD admissions. The mean age of patients was 67.44 (standard deviation 16.72) years. It was estimated that 25.7% of PVCs were no longer necessary. Staphylococcus aureus was the most frequently isolated micro-organism (41.7%). Phlebitis was clinically evident in 44 (62.9%) episodes, and proved to be an independent predictor of catheter insertion in emergency departments (odds ratio 5.44). The crude and attributable mortality rates were 12.9% and 5.7%, respectively. CONCLUSIONS PVCs carry a significant risk for bacteraemia in Spanish IMDs. Phlebitis is not always clinically evident in patients with bacteraemia in this population. The study findings support the need for educational and interventional preventive measures in both IMDs and emergency departments to reduce the rate of PVC-BSI and associated comorbidities, and costs.
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Affiliation(s)
- M Guembe
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - M J Pérez-Granda
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J A Capdevila
- Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain; Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain
| | - J Barberán
- Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain; Department of Internal Medicine, Hospital de Montepríncipe, Madrid, Spain
| | - B Pinilla
- Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain; Department of Internal Medicine, HGU Gregorio Marañón, Madrid, Spain
| | - P Martín-Rabadán
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Study Group of Infections of the Sociedad Española de Infecciones Cardiovasculares, Madrid, Spain
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Salgado Yepez E, Bovera MM, Rosenthal VD, González Flores HA, Pazmiño L, Valencia F, Alquinga N, Ramirez V, Jara E, Lascano M, Delgado V, Cevallos C, Santacruz G, Pelaéz C, Zaruma C, Barahona Pinto D. Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium’s findings. World J Biol Chem 2017; 8:95-101. [PMID: 28289522 PMCID: PMC5329718 DOI: 10.4331/wjbc.v8.i1.95] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 12/06/2016] [Accepted: 01/18/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To report the results of the International Nosocomial Infection Control Consortium (INICC) study conducted in Quito, Ecuador.
METHODS A device-associated healthcare-acquired infection (DA-HAI) prospective surveillance study conducted from October 2013 to January 2015 in 2 adult intensive care units (ICUs) from 2 hospitals using the United States Centers for Disease Control/National Healthcare Safety Network (CDC/NHSN) definitions and INICC methods.
RESULTS We followed 776 ICU patients for 4818 bed-days. The central line-associated bloodstream infection (CLABSI) rate was 6.5 per 1000 central line (CL)-days, the ventilator-associated pneumonia (VAP) rate was 44.3 per 1000 mechanical ventilator (MV)-days, and the catheter-associated urinary tract infection (CAUTI) rate was 5.7 per 1000 urinary catheter (UC)-days. CLABSI and CAUTI rates in our ICUs were similar to INICC rates [4.9 (CLABSI) and 5.3 (CAUTI)] and higher than NHSN rates [0.8 (CLABSI) and 1.3 (CAUTI)] - although device use ratios for CL and UC were higher than INICC and CDC/NSHN’s ratios. By contrast, despite the VAP rate was higher than INICC (16.5) and NHSN’s rates (1.1), MV DUR was lower in our ICUs. Resistance of A. baumannii to imipenem and meropenem was 75.0%, and of Pseudomonas aeruginosa to ciprofloxacin and piperacillin-tazobactam was higher than 72.7%, all them higher than CDC/NHSN rates. Excess length of stay was 7.4 d for patients with CLABSI, 4.8 for patients with VAP and 9.2 for patients CAUTI. Excess crude mortality in ICUs was 30.9% for CLABSI, 14.5% for VAP and 17.6% for CAUTI.
CONCLUSION DA-HAI rates in our ICUs from Ecuador are higher than United States CDC/NSHN rates and similar to INICC international rates.
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Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016. [DOI: 10.1017/s0899823x00193870] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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7
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Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC, Boersma E, Helder OK. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2016; 16:724-734. [PMID: 26907734 DOI: 10.1016/s1473-3099(15)00409-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Central-line-associated bloodstream infections (CLABSIs) are a major problem in intensive care units (ICUs) worldwide. We aimed to quantify the effectiveness of central-line bundles (insertion or maintenance or both) to prevent these infections. METHODS We searched Embase, MEDLINE OvidSP, Web-of-Science, and Cochrane Library to identify studies reporting the implementation of central-line bundles in adult ICU, paediatric ICU (PICU), or neonatal ICU (NICU) patients. We searched for studies published between Jan 1, 1990, and June 30, 2015. For the meta-analysis, crude estimates of infections were pooled by use of a DerSimonian and Laird random effect model. The primary outcome was the number of CLABSIs per 1000 catheter-days before and after implementation. Incidence risk ratios (IRRs) were obtained by use of random-effects models. FINDINGS We initially identified 4337 records, and after excluding duplicates and those ineligible, 96 studies met the eligibility criteria, 79 of which contained sufficient information for a meta-analysis. Median CLABSIs incidence were 5·7 per 1000 catheter-days (range 1·2-46·3; IQR 3·1-9·5) on adult ICUs; 5·9 per 1000 catheter-days (range 2·6-31·1; 4·8-9·4) on PICUs; and 8·4 per 1000 catheter-days (range 2·6-24·1; 3·7-16·0) on NICUs. After implementation of central-line bundles the CLABSI incidence ranged from 0 to 19·5 per 1000 catheter-days (median 2·6, IQR 1·2-4·4) in all types of ICUs. In our meta-analysis the incidence of infections decreased significantly from median 6·4 per 1000 catheter-days (IQR 3·8-10·9) to 2·5 per 1000 catheter-days (1·4-4·8) after implementation of bundles (IRR 0·44, 95% CI 0·39-0·50, p<0·0001; I(2)=89%). INTERPRETATION Implementation of central-line bundles has the potential to reduce the incidence of CLABSIs. FUNDING None.
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Affiliation(s)
- Erwin Ista
- Intensive Care Unit, Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
| | | | - René F Kornelisse
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Cynthia van der Starre
- Intensive Care Unit, Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, Netherlands
| | - Eric Boersma
- Department of Cardiology, Cardiovascular Research School COEUR, Erasmus MC, Rotterdam, Netherlands
| | - Onno K Helder
- Department of Paediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
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Marang-van de Mheen PJ, van Bodegom-Vos L. Meta-analysis of the central line bundle for preventing catheter-related infections: a case study in appraising the evidence in quality improvement. BMJ Qual Saf 2015; 25:118-29. [DOI: 10.1136/bmjqs-2014-003787] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 07/01/2015] [Indexed: 11/04/2022]
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Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. ACTA ACUST UNITED AC 2015. [DOI: 10.1017/s0195941700095412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O'Grady NP, Pettis AM, Rupp ME, Sandora T, Maragakis LL, Yokoe DS. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35:753-71. [PMID: 25376071 DOI: 10.1086/676533] [Citation(s) in RCA: 293] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Martín-Rabadán P, Bouza E. Nationwide study on the use of intravascular catheters in internal medicine departments. J Hosp Infect 2015; 90:135-41. [PMID: 25824558 DOI: 10.1016/j.jhin.2015.01.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 01/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of intravascular catheters (IVCs) in intensive care units (ICUs) has been well assessed in recent years. However, a high proportion of these devices are placed in patients outside the ICU, particularly in internal medicine departments (IMDs), where data on the quality of care are scarce. AIM To assess the use and management of IVCs in IMDs in Spain. METHODS We performed a point prevalence study of all adult inpatients on 47 IMDs from hospitals of different sizes on one day in June 2013. A local co-ordinator was appointed to assess patients and collect data from each site. FINDINGS Out of the 2080 adult patients hospitalized on the study day, 1703 (81.9%) had one or more IVCs (95.4% of which were peripheral devices). Infection was detected at the insertion site in 92 catheters (5.0%); 87 patients (5.2%) had signs of sepsis, but only one case was considered to be catheter-related. The local co-ordinators estimated that 19% of the catheters in place were no longer necessary. A daily record of the need for a catheter was available in only 40.6% of cases. CONCLUSION Our study shows clear opportunities for improvement regarding catheter use and care in Spanish IMDs. Strategies similar to those applied in ICUs should be implemented in IMDs.
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Affiliation(s)
- M Guembe
- Department of Clinical Microbiology and Infectious Diseases, HGU Gregorio Marañón, Madrid, Spain.
| | - M J Pérez-Granda
- Cardiac Surgery Postoperative Care Unit, HGU Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias ‒ CIBERES (CB06/06/0058), Madrid, Spain
| | - J A Capdevila
- Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain; Study Group of Infections of the Sociedad Española de Medicina Interna (SEMI), Spain
| | - J Barberán
- Department of Internal Medicine, Hospital de Montepríncipe, Madrid, Spain; Study Group of Infections of the Sociedad Española de Medicina Interna (SEMI), Spain
| | - B Pinilla
- Department of Internal Medicine, HGU Gregorio Marañón, Madrid, Spain
| | - P Martín-Rabadán
- Department of Clinical Microbiology and Infectious Diseases, HGU Gregorio Marañón, Madrid, Spain
| | - E Bouza
- Department of Clinical Microbiology and Infectious Diseases, HGU Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Study Group of Infections of the Sociedad Española de Medicina Interna (SEMI), Spain; CIBER Enfermedades Respiratorias ‒ CIBERES (CB06/06/0058), Madrid, Spain
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12
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Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D. Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clin Infect Dis 2014; 59:96-105. [PMID: 24723276 DOI: 10.1093/cid/ciu239] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This systematic review and meta-analysis examines the impact of quality improvement interventions on central line-associated bloodstream infections in adult intensive care units. Studies were identified through Medline and manual searches (1995-June 2012). Random-effects meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Meta-regression assessed the impact of bundle/checklist interventions and high baseline rates on intervention effect. Forty-one before-after studies identified an infection rate decrease (OR, 0.39 [95% CI, .33-.46]; P < .001). This effect was more pronounced for trials implementing a bundle or checklist approach (P = .03). Furthermore, meta-analysis of 6 interrupted time series studies revealed an infection rate reduction 3 months postintervention (OR, 0.30 [95% CI, .10-.88]; P = .03). There was no difference in infection rates between studies with low or high baseline rates (P = .18). These results suggest that quality improvement interventions contribute to the prevention of central line-associated bloodstream infections. Implementation of care bundles and checklists appears to yield stronger risk reductions.
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Affiliation(s)
- Koen Blot
- Faculty of Medicine and Health Sciences, Ghent University
| | - Jochen Bergs
- Health Economics and Patient Safety, Hasselt University, Hasselt, Belgium
| | - Dirk Vogelaers
- Faculty of Medicine and Health Sciences, Ghent University General Internal Medicine, Ghent University Hospital, Ghent
| | - Stijn Blot
- Faculty of Medicine and Health Sciences, Ghent University Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
| | - Dominique Vandijck
- Faculty of Medicine and Health Sciences, Ghent University General Internal Medicine, Ghent University Hospital, Ghent Health Economics and Patient Safety, Hasselt University, Hasselt, Belgium
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García-Rodríguez JF, Álvarez-Díaz H, Vilariño-Maneiro L, Lorenzo-García MV, Cantón-Blanco A, Ordoñez-Barrosa P, Mariño-Callejo AI, Sesma-Sánchez P. Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit. BMC Infect Dis 2013; 13:445. [PMID: 24063563 PMCID: PMC3849631 DOI: 10.1186/1471-2334-13-445] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 09/20/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Outside ICUs, CVC-ABSIs epidemiology and the results of strategies for their prevention are not well known. The aim of this study was to investigate the epidemiology and the impact of a multifaceted "bundle" approach in controlling CVC-ABSIs outside ICU. METHODS From 1991 we performed prevalence studies of device and parenteral nutrition use, and prospective surveillance of all episodes of CVC-ABSIs in a 350-bed teaching hospital. CVC-ABSIs incidence/1,000 inpatient-days was calculated. An estimated CVC-ABSIs incidence/1,000 catheter-days was calculated based on the prevalence rates of catheter use and the total number of inpatient-days in each year. On november 2008, an education programme was instituted for care of catheter lines: reinforcing instructions in aseptic insertion technique, after care and hand-washing; in order to assess the adherence to these measures the quantity of alcohol-based hand-rub consumption/1,000 patient-days was quoted in litres. From January 2009, a checklist intervention for CVC insertion in ICU was started: hand hygiene, using full barrier precautions, cleaning the skin with alcoholic chlorhexidine, avoiding femoral access and removing unnecessary catheters. Compliance with the central line insertion checklist was measured by real-time audits and was achieved in 80% of cases. RESULTS Prevalence of use of CVC and parenteral nutrition was similar throughout the study. We followed-up 309 CVC-ABSIs cases. Estimated CVC-ABSIs rate progressively increased to 15.1/1,000 catheter-days in 2008 (0.36/1,000 inpatient-days). After the intervention, the alcohol-based hand-rub consumption increased slightly and estimated CVC-ABSIs rate fell to 10.1 /1,000 catheter-days in last three years (0.19/1,000 inpatient-days), showing a 32.9% decrease. The infection rates achieved were lower in Internal Medicine wards: decreased from 14.1/1,000 catheter-days (0.17/patient-days) in 2008 to 5.2/1,000 catheter-days (0.05/1,000 inpatient-days) in last three years, showing a 63.1% decrease. In 2009, the estimated CVC-ABSIs incidence rate was significantly lower in the Internal Medicine ward compared to the Surgery ward: rate ratio (RR) = 0.14, 95%CI: 0.03-0.60), and within the Internal Medicine ward, the estimated CVC-ABSIs incidence rate was significantly lower in 2009 compared to 2008 (RR = 0.20, 95%CI: 0.04-0.91). CONCLUSION The rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.
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Affiliation(s)
- José Francisco García-Rodríguez
- Infectious Diseases Unit, Internal Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain
- C/ San Amaro 10-12, 6° Derecha, 15403, Ferrol, La Coruña, Spain
| | - Hortensia Álvarez-Díaz
- Infectious Diseases Unit, Internal Medicine Ward, Health Area of Ferrol, SERGAS, La Coruña, Spain
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14
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Flodgren G, Conterno LO, Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database Syst Rev 2013:CD006559. [PMID: 23543545 DOI: 10.1002/14651858.cd006559.pub2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a major threat to patient safety, and are associated with mortality rates varying from 5% to 35%. Important risk factors associated with HAIs are the use of invasive medical devices (e.g. central lines, urinary catheters and mechanical ventilators), and poor staff adherence to infection prevention practices during insertion and care for the devices when in place. There are specific risk profiles for each device, but in general, the breakdown of aseptic technique during insertion and care for the device, as well as the duration of device use, are important factors for the development of these serious and costly infections. OBJECTIVES To assess the effectiveness of different interventions, alone or in combination, which target healthcare professionals or healthcare organisations to improve professional adherence to infection control guidelines on device-related infection rates and measures of adherence. SEARCH METHODS We searched the following electronic databases for primary studies up to June 2012: the Cochrane Effective Paractice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL. We searched reference lists and contacted authors of included studies. We also searched the Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effectiveness (DARE) for related reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and interrupted time series (ITS) studies that complied with the Cochrane EPOC Group methodological criteria, and that evaluated interventions to improve professional adherence to guidelines for the prevention of device-related infections. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of each included study using the Cochrane EPOC 'Risk of bias' tool. We contacted authors of original papers to obtain missing information. MAIN RESULTS We included 13 studies: one cluster randomised controlled trial (CRCT) and 12 ITS studies, involving 40 hospitals, 51 intensive care units (ICUs), 27 wards, and more than 3504 patients and 1406 healthcare professionals. Six of the included studies targeted adherence to guidelines to prevent central line-associated blood stream infections (CLABSIs); another six studies targeted adherence to guidelines to prevent ventilator-associated pneumonia (VAP), and one study focused on interventions to improve urinary catheter practices. We judged all included studies to be at moderate or high risk of bias.The largest median effect on rates of VAP was found at nine months follow-up with a decrease of 7.36 (-10.82 to 3.14) cases per 1000 ventilator days (five studies and 15 sites). The one included cluster randomised controlled trial (CRCT) observed, improved urinary catheter practices five weeks after the intervention (absolute difference 12.2 percentage points), however, the statistical significance of this is unknown given a unit of analysis error. It is worth noting that N = 6 interventions that did result in significantly decreased infection rates involved more than one active intervention, which in some cases, was repeatedly administered over time, and further, that one intervention involving specialised oral care personnel showed the largest step change (-22.9 cases per 1000 ventilator days (standard error (SE) 4.0), and also the largest slope change (-6.45 cases per 1000 ventilator days (SE 1.42, P = 0.002)) among the included studies. We attempted to combine the results for studies targeting the same indwelling medical device (central line catheters or mechanical ventilators) and reporting the same outcomes (CLABSI and VAP rate) in two separate meta-analyses, but due to very high statistical heterogeneity among included studies (I(2) up to 97%), we did not retain these analyses. Six of the included studies reported post-intervention adherence scores ranging from 14% to 98%. The effect on rates of infection were mixed and the effect sizes were small, with the largest median effect for the change in level (interquartile range (IQR)) for the six CLABSI studies being observed at three months follow-up was a decrease of 0.6 (-2.74 to 0.28) cases per 1000 central line days (six studies and 36 sites). This change was not sustained over longer follow-up times. AUTHORS' CONCLUSIONS The low to very low quality of the evidence of studies included in this review provides insufficient evidence to determine with certainty which interventions are most effective in changing professional behaviour and in what contexts. However, interventions that may be worth further study are educational interventions involving more than one active element and that are repeatedly administered over time, and interventions employing specialised personnel, who are focused on an aspect of care that is supported by evidence e.g. dentists/dental auxiliaries performing oral care for VAP prevention.
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Affiliation(s)
- Gerd Flodgren
- Department of Public Health, University of Oxford, Oxford, UK.
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15
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Almirante B, Limón E, Freixas N, Gudiol F. Laboratory-based surveillance of hospital-acquired catheter-related bloodstream infections in Catalonia. Results of the VINCat Program (2007-2010). Enferm Infecc Microbiol Clin 2013; 30 Suppl 3:13-9. [PMID: 22776149 DOI: 10.1016/s0213-005x(12)70091-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The VINCat Program is an institutional surveillance program for hospital-acquired infections developed in the healthcare institutions of Catalonia, Spain. The program includes the monitoring of various components of hospital-acquired infection, among which is catheter-related bloodstream infection (CRBSI). The aim of this study was to describe the frequency of CRBSI in hospitals participating in the VINCat Program over a period of 4 years (2007-2010). The monitoring of the CRBSI component is carried out continuously in all inpatient units by performing a daily assessment of all blood culture results issued by the Microbiology Laboratories. Precise definitions are used for CRBSI, and adjusted rates are expressed per 1,000 days of hospitalization, hospital size and type of catheter. The rates of CRBSI in catheters used for parenteral nutrition are adjusted and expressed per 1,000 days of device use. The aggregate data of the total period are shown in percentiles (10%, 25%, 50% or median, 75%, and 90%). From 2007 to 2010, a total of 2977 episodes of CRBSI were reported in 40 hospitals participating in the VINCat Program. The cumulative incidence of CRBSI has been 0.26 episodes per 1,000 days of hospitalization (CI95% 0.2 to 0.3). The overall incidence varied depending on hospital size: 0.36 ‰ for hospitals in Group I (>500 beds), 0.17 ‰ for Group II (200-500 beds), and 0.09 ‰ for Group III (<200 beds). 76% of the episodes were associated with central venous catheters (CVC), 19% of the episodes with peripheral venous catheters (PVC), and the remaining 5% with peripherally inserted CVCs (PICC). The most common organisms causing CRBSI were staphylococci, the group Klebsiella, Serratia and Enterobacter, Candida spp., and Pseudomonas aeruginosa. There are important differences in the etiology of CRBSI in relation to these variables. During the reporting period, a significant reduction (38.1%, CI95%, 29.0-46.0%) of CRBSI rates have been observed in Group I hospitals. CRBSI surveillance is an important element of the VINCat Program, offering to us the possibility of establishing standard values for this component and implementing intervention strategies for its reduction.
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Affiliation(s)
- Benito Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
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17
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Faruqi A, Medefindt J, Dutta G, Philip SA, Tompkins D, Carey J. Effect of a multidisciplinary intervention on central line utilization in an acute care hospital. Am J Infect Control 2012; 40:e211-5. [PMID: 22418611 DOI: 10.1016/j.ajic.2011.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 12/14/2011] [Accepted: 12/14/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many institutions that have adopted evidence-based infection prevention practices have achieved reductions in the rate of central line-associated bloodstream infection (CLABSI) in their intensive care units (ICUs). Few studies have investigated the impact of CLABSI prevention strategies in non-ICU settings, however. This study was conducted to assess whether a multifaceted educational initiative significantly improved health care workers' adherence to clinical practices that have been demonstrated to reduce CLABSI rates. METHODS This prospective interventional study compared central line utilization and other variables in medical ICU (MICU) and non-ICU settings at an inner city community teaching hospital. The study included 3 phases: preintervention, intervention, and postintervention. RESULTS A total of 128 central venous catheter (CVC) placements were reviewed. After the intervention, the proportion of patients transferred out of the MICU with a CVC in place decreased significantly (P = .05), and the percentage of patients transitioned from a CVC to a peripherally inserted venous catheter increased (P = .004). The mean duration of CVC use decreased from 8.2 days to 5.7 days (P = .004), which was confirmed by linear regression (P = .003). CONCLUSIONS Our data indicate that multidisciplinary, evidenced-based educational interventions can significantly improve targeted measures of CVC use. Our program was successfully implemented with limited resources and should be reproducible at other hospitals.
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Affiliation(s)
- Ayesha Faruqi
- Department of Internal Medicine, Lutheran Medical Center, Brooklyn, NY 11220, USA
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Liang SY, Khair H, Durkin MJ, Marschall J. Prevention and management of central line-associated bloodstream infections in hospital practice. Hosp Pract (1995) 2012; 40:106-18. [PMID: 22406886 DOI: 10.3810/hp.2012.02.951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this article aimed at hospitalists, we examine the literature on preventive measures for central line-associated bloodstream infections (CLABSIs) and optimal management once a CLABSI has been established. We focus on a number of core preventive measures and the contemporary approach of bundling these measures for maximal impact in reducing infection rates. We then discuss empiric and pathogen-specific antibiotic therapy, including the role of newer antimicrobial agents, as well as the management of an infected central venous catheter.
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Affiliation(s)
- Stephen Y Liang
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110-1093, USA
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