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McManus C, Mifflin N, Rivera R, Vause S, Tran T, Ostroff M, Harrowell L, Frost S, Alexandrou E. Comparison of outcomes from tunnelled femorally inserted central catheters and peripherally inserted central catheters: a propensity score-matched cohort study. BMJ Open 2024; 14:e081749. [PMID: 38760049 PMCID: PMC11103188 DOI: 10.1136/bmjopen-2023-081749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/14/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES To compare catheter-related outcomes of individuals who received a tunnelled femorally inserted central catheter (tFICC) with those who received a peripherally inserted central catheter (PICC) in the upper extremities. DESIGN A propensity-score matched cohort study. SETTING A 980-bed tertiary referral hospital in South West Sydney, Australia. PARTICIPANTS In-patients referred to the hospital central venous access service for the insertion of a central venous access device. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome of interest was the incidence of all-cause catheter failure. Secondary outcomes included the rates of catheters removed because of suspected or confirmed catheter-associated infection, catheter dwell and confirmed upper or lower extremity deep vein thrombosis (DVT). RESULTS The overall rate of all-cause catheter failure in the matched tFICC and PICC cohort was 2.4/1000 catheter days (95% CI 1.1 to 4.4) and 3.0/1000 catheter days (95% CI 2.3 to 3.9), respectively, and when compared, no difference was observed (difference -0.63/1000 catheter days, 95% CI -2.32 to 1.06). We found no differences in catheter dwell (mean difference of 14.2 days, 95% CI -6.6 to 35.0, p=0.910); or in the cumulative probability of failure between the two groups within the first month of dwell (p=0.358). No significant differences were observed in the rate of catheters requiring removal for confirmed central line-associated bloodstream infection (difference 0.13/1000 catheter day, 95% CI -0.36 to 0.63, p=0.896). Similarly, no significant differences were found between the groups for confirmed catheter-related DVT (difference -0.11 per 1000 catheter days, 95% CI -0.26 to 0.04, p=1.00). CONCLUSION There were no differences in catheter-related outcomes between the matched cohort of tFICC and PICC patients, suggesting that tFICCs are a possible alternative for vascular access when the veins of the upper extremities or thoracic region are not viable for catheterisation.
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Affiliation(s)
- Craig McManus
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Nicholas Mifflin
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Renz Rivera
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Sophie Vause
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ton Tran
- Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Matthew Ostroff
- St Joseph's Health and Medical Centre, Emerson, New Jersey, USA
| | - Lorenza Harrowell
- Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Steven Frost
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
| | - Evan Alexandrou
- Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Nursing, University of Wollongong, Faculty of Science Medicine and Health, Wollongong, New South Wales, Australia
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Nelson SE, Tsetsou S, Liang J. Leaving no culture undrawn: Time to revisit the CLABSI and CAUTI metrics. J Crit Care 2024; 79:154442. [PMID: 37797403 DOI: 10.1016/j.jcrc.2023.154442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
Central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are quality metrics for many ICUs, and financial ramifications can be applied to hospitals and providers who perform poorly on these measures. Despite some perceived benefits to tracking these metrics, there are a range of issues associated with this practice: lack of a solid evidence base that documenting them has led to decreased infection rates, moral distress associated with identifying these infections, problems with their definitions, and others. We discuss each of these concerns while also including international perspectives then recommend practical steps to attempt to remediate use of the CLABSI and CAUTI metrics. Specifically, we suggest forming a task force consisting of key stakeholders (e.g., providers, Centers for Medicare & Medicaid Services (CMS), patients/families) to review CLABSI and CAUTI-related issues and then to create a summary statement containing recommendations to improve the use of these metrics.
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Affiliation(s)
- Sarah E Nelson
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA; Department of Neurology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA; Department of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Spyridoula Tsetsou
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA; Departments of Neurology and Neurosurgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - John Liang
- Departments of Neurosurgery and Neurology, Mount Sinai West, 1000 10(th) Avenue, Suite 10B-65, New York, NY 10019, USA
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Kannan S, Bruch JD, Song Z. Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition. JAMA 2023; 330:2365-2375. [PMID: 38147093 PMCID: PMC10751598 DOI: 10.1001/jama.2023.23147] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/22/2023] [Indexed: 12/27/2023]
Abstract
Importance The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown. Objective To examine changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals. Design, Setting, and Participants Data from 100% Medicare Part A claims for 662 095 hospitalizations at 51 private equity-acquired hospitals were compared with data for 4 160 720 hospitalizations at 259 matched control hospitals (not acquired by private equity) for hospital stays between 2009 and 2019. An event study, difference-in-differences design was used to assess hospitalizations from 3 years before to 3 years after private equity acquisition using a linear model that was adjusted for patient and hospital attributes. Main Outcomes and Measures Hospital-acquired adverse events (synonymous with hospital-acquired conditions; the individual conditions were defined by the US Centers for Medicare & Medicaid Services as falls, infections, and other adverse events), patient mix, and hospitalization outcomes (including mortality, discharge disposition, length of stay, and readmissions). Results Hospital-acquired adverse events (or conditions) were observed within 10 091 hospitalizations. After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004). This increase in hospital-acquired conditions was driven by a 27.3% increase in falls (P = .02) and a 37.7% increase in central line-associated bloodstream infections (P = .04) at private equity hospitals, despite placing 16.2% fewer central lines. Surgical site infections doubled from 10.8 to 21.6 per 10 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume; meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations. Compared with Medicare beneficiaries treated at control hospitals, those treated at private equity hospitals were modestly younger, less likely to be dually eligible for Medicare and Medicaid, and more often transferred to other acute care hospitals after shorter lengths of stay. In-hospital mortality (n = 162 652 in the population or 3.4% on average) decreased slightly at private equity hospitals compared with the control hospitals; there was no differential change in mortality by 30 days after hospital discharge. Conclusions and Relevance Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line-associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections. Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals, which was no longer evident 30 days after discharge. These findings heighten concerns about the implications of private equity on health care delivery.
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Affiliation(s)
- Sneha Kannan
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Joseph Dov Bruch
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Zirui Song
- Department of Health Care Policy, Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- Center for Primary Care, Harvard Medical School, Harvard University, Boston, Massachusetts
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Saint S, Greene MT, Krein SL, Fowler KE, Linder KA, Ratz D, Meddings J. What US hospitals are doing to prevent common device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: Results from a national survey in the United States. Infect Control Hosp Epidemiol 2023; 44:1913-1919. [PMID: 37259703 PMCID: PMC10755151 DOI: 10.1017/ice.2023.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The ways that device-associated infection prevention practices changed during the coronavirus disease 2019 (COVID-19) pandemic remain unknown. We collected data mid-pandemic to assess the use of several infection prevention practices and for comparison with historical data. DESIGN Repeated cross-sectional survey. SETTING US acute-care hospitals. PARTICIPANTS Infection preventionists. METHODS We surveyed infection preventionists from a national random sample of 881 US acute-care hospitals in 2021 to estimate the current use of practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated events (VAE). We compared the 2021 results with those from surveys occurring every 4 years since 2005. RESULTS The 2021 survey response rate was 47%; previous survey response rates ranged from 59% to 72%. Regular use of most practices to prevent CLABSI (chlorhexidine gluconate for site antisepsis, 99.0%, and maximum sterile barrier precautions, 98.7%) and VAE (semirecumbent positioning, 93.4%, and sedation vacation, 85.8%) continued to increase or plateaued in 2021. Conversely, use of several CAUTI prevention practices (portable bladder ultrasound scanner, 65.6%; catheter reminders or nurse-initiated discontinuation, 66.3%; and intermittent catheterization, 37.3%) was lower in 2021, with a significant decrease for some practices compared to 2017 (P ≤ .02 for all comparisons). In 2021, 42.1% of hospitals reported regular use of the newer external urinary collection devices for women. CONCLUSIONS Although regular use of CLABSI and VAE preventive practices continued to increase (or plateaued), use of several CAUTI preventive practices decreased during the COVID-19 pandemic. Structural issues relating to care during the pandemic may have contributed to a decrease in device-associated infection prevention practices.
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Affiliation(s)
- Sanjay Saint
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - M. Todd Greene
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Sarah L. Krein
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Karen E. Fowler
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Kathleen A. Linder
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
- Infectious Disease Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Jennifer Meddings
- Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- VA/UM Patient Safety Enhancement Program, Ann Arbor, Michigan
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
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5
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Dang F, Zhai T, Ding N, Gao J, Li R, Li H, Ran X. Development and Validation of a Questionnaire to Measure ICU Nurses' Knowledge, Attitudes, and Practices Related to Central Line Bloodstream Infection Practices. J Nurs Care Qual 2023; 38:E59-E65. [PMID: 36917825 PMCID: PMC10442122 DOI: 10.1097/ncq.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Currently, there is no instrument available to assess intensive care unit (ICU) nurses' knowledge, attitudes, and practices (KAP) of central line-associated bloodstream infection (CLABSI) prevention practices. PURPOSE To develop and validate a CLABSI questionnaire to measure ICU nurses' KAP (CLABSI-KAP-Q). METHODS Data were collected from 255 nurses at 4 hospitals in Gansu Province, China. Questions on the CLABSI-KAP-Q were generated through a review of the literature, interviews with nurses, and multiple rounds of content validity evaluation by experts. The validity and reliability of the CLABSI-KAP-Q were assessed with exploratory factor analysis, confirmatory factor analysis, internal consistency, and correlation coefficients. RESULTS The final version of the CLABSI-KAP-Q consisted of 32 items. The reliability was represented by a Cronbach α of 0.946, while the test-retest reliability was 0.945. The overall content validity was 0.95. CONCLUSIONS The CLABSI-KAP-Q is shown to be valid and reliable and recommended for use in clinical practice.
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Affiliation(s)
- Fangping Dang
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Tiantian Zhai
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Nannan Ding
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Jing Gao
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Rao Li
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Huiju Li
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
| | - Xingwu Ran
- West China School of Nursing (Dang and Li and Dr Ran), and Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital (Dang and R. Li and Dr Ran), Sichuan University, Chengdu, China; School of Nursing, Lanzhou University, Lanzhou, China (Dang, Zhai, Ding, Gao, and Dr H. Li); Lanzhou University Second Hospital, Lanzhou, China (Zhai and Gao); and Henan Provincial People's Hospital, Zhengzhou, China (Ding)
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Popovich KJ, Aureden K, Ham DC, Harris AD, Hessels AJ, Huang SS, Maragakis LL, Milstone AM, Moody J, Yokoe D, Calfee DP. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:1039-1067. [PMID: 37381690 PMCID: PMC10369222 DOI: 10.1017/ice.2023.102] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
Previously published guidelines have provided 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 efforts to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. This document updates the "Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals" published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Affiliation(s)
- Kyle J. Popovich
- Department of Internal Medicine, RUSH Medical College, Chicago, Illinois
| | - Kathy Aureden
- Infection Prevention, Advocate Aurora Health, Downers Grove, Illinois
| | - D. Cal Ham
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anthony D. Harris
- Health Care Outcomes Research, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amanda J. Hessels
- Columbia School of Nursing, New York, New York
- Hackensack Meridian Health, Edison, New Jersey
| | - Susan S. Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Aaron M. Milstone
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Moody
- Infection Prevention, HCA Healthcare, Nashville, Tennessee
| | - Deborah Yokoe
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
- Transplant Infectious Diseases, UCSF Medical Center, San Francisco, California
| | - David P. Calfee
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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Developing a Nurse-Driven Vascular Access Device Order Set Using the Electronic Medical Record. JOURNAL OF INFUSION NURSING 2021; 45:20-26. [PMID: 34941606 DOI: 10.1097/nan.0000000000000450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The creation of an electronic order set to identify appropriate vascular access device utilization was the basis of this prospective quality improvement investigation, at a Level 1 trauma center in southeastern Pennsylvania. The data used in this investigation were gathered over a 36-month time frame from January 2017 through December 2019. This patient-centered approach utilized the evidence-based guidelines developed from The Michigan Appropriateness Guide for Intravenous Catheters and recommendations from the Infusion Therapy Standards of Practice. The algorithmic approach developed by vascular access nurses led to statistically significant reductions in unnecessary peripherally inserted central catheter placement. The results also demonstrated an increase in appropriately placed peripheral intravenous catheters. Leveraging the electronic medical record with nursing expertise fosters patient safety across the continuum of care.
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8
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Selby LM, Rupp ME, Cawcutt KA. Prevention of Central-Line Associated Bloodstream Infections: 2021 Update. Infect Dis Clin North Am 2021; 35:841-856. [PMID: 34752222 DOI: 10.1016/j.idc.2021.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite a large volume of research in prevention, central line-associated bloodstream infections and catheter-related bloodstream infections continue to cause significant morbidity, mortality, and increased health care costs. Strategies in prevention, including decision about catheter placement, insertion bundles, adherence to standard of care guidelines, and technologic innovations, shown to decrease rates of catheter-related bloodstream infections and central line-associated bloodstream infections are described in this update. The coronavirus disease 2019 pandemic has resulted in increased health care-acquired infections, including central line-associated bloodstream infections.
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Affiliation(s)
- Laura M Selby
- Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Kelly A Cawcutt
- Division of Infectious Diseases, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA.
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Goldman J, Rotteau L, Shojania KG, Baker GR, Rowland P, Christianson MK, Vogus TJ, Cameron C, Coffey M. Implementation of a central-line bundle: a qualitative study of three clinical units. Implement Sci Commun 2021; 2:105. [PMID: 34530918 PMCID: PMC8447632 DOI: 10.1186/s43058-021-00204-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Evidence for the central line-associated bloodstream infection (CLABSI) bundle effectiveness remains mixed, possibly reflecting implementation challenges and persistent ambiguities in how CLABSIs are counted and bundle adherence measured. In the context of a tertiary pediatric hospital that had reduced CLABSI by 30% as part of an international safety program, we aimed to examine unit-based socio-cultural factors influencing bundle practices and measurement, and how they come to be recognized and attended to by safety leaders over time in an organization-wide bundle implementation effort. Methods We used an interpretivist qualitative research approach, based on 74 interviews, approximately 50 h of observations, and documents. Data collection focused on hospital executives and safety leadership, and three clinical units: a medical specialty unit, an intensive care unit, and a surgical unit. We used thematic analysis and constant comparison methods for data analysis. Results Participants had variable beliefs about the central-line bundle as a quality improvement priority based on their professional roles and experiences and unit setting, which influenced their responses. Nursing leaders were particularly concerned about CLABSI being one of an overwhelming number of QI targets for which they were responsible. Bundle implementation strategies were initially reliant on unit-based nurse education. Over time there was recognition of the need for centralized education and reinforcement tactics. However, these interventions achieved limited impact given the influence of competing unit workflow demands and professional roles, interactions, and routines, which were variably targeted in the safety program. The auditing process, initially a responsibility of units, was performed in different ways based on individuals’ approaches to the process. Given concerns about auditing reliability, a centralized approach was implemented, which continued to have its own variability. Conclusions Our findings report on a contextualized, dynamic implementation approach that required movement between centralized and unit-based approaches and from a focus on standardization to some recognition of a role for customization. However, some factors related to bundle compliance and measurement remain unaddressed, including harder to change socio-cultural factors likely important to sustainability of the CLABSI reductions and fostering further improvements across a broader safety agenda.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, 630-525 University Ave., Toronto, M5G2L3, Canada. .,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. .,Wilson Centre for Research in Education, University of Toronto, 200 Elizabeth St., 1ES-565, Toronto, M5G 2C4, Canada.
| | - Leahora Rotteau
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, 630-525 University Ave., Toronto, M5G2L3, Canada
| | - Kaveh G Shojania
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, 630-525 University Ave., Toronto, M5G2L3, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College St., Suite 425, Toronto, M5T 3M6, Canada
| | - Paula Rowland
- Wilson Centre for Research in Education, University of Toronto, 200 Elizabeth St., 1ES-565, Toronto, M5G 2C4, Canada.,Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Marlys K Christianson
- Rotman School of Management, University of Toronto, 125 St. George St., Toronto, M5S 2E8, Canada
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, 401 21st Avenue South, Nashville, TN, 37203, USA
| | - Connie Cameron
- The Hospital for Sick Children, 555 University Ave., Toronto, M5G 1X8, Canada
| | - Maitreya Coffey
- The Hospital for Sick Children, 555 University Ave., Toronto, M5G 1X8, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Children's Hospitals Solutions for Patient Safety, Cincinnati, OH, USA
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10
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Effect of coronavirus disease 2019 (COVID-19) pandemic on catheter-related bloodstream infections: Control measures should not be relaxed. Infect Control Hosp Epidemiol 2021; 43:1298-1300. [PMID: 34039456 PMCID: PMC8193183 DOI: 10.1017/ice.2021.258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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11
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Trends in central-line-associated bloodstream infections and catheter-associated urinary tract infections in a large acute-care hospital system in New York City, 2016-2019. Infect Control Hosp Epidemiol 2020; 42:842-846. [PMID: 33208201 DOI: 10.1017/ice.2020.1293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Central-line bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) negatively impact clinical outcomes and hospital reimbursement. In this report, 4 year trends involving 11 hospitals in New York City were examined. METHODS Data from the National Healthcare Safety Network (NHSN) were extracted for 11 acute-care hospitals belonging to the NYC Health + Hospital system from 2016 through 2019. Trends in device infections per 1,000 patient days, device utilization ratios, and standardized infection ratios (SIRs) were examined for the 11 hospitals and for the entire system. RESULTS Over the 4-year period, there were progressive declines in central-line days, infections per 1,000 central-line days, and device utilization ratios for the system. The average annual SIRs for the system also declined: 1.40 in 2016, 1.09 in 2017, 1.04 in 2018, and 0.82 in 2019. Case-mix indices correlated with SIRs for CLABSIs. Level 1 trauma centers had higher SIRs and a disproportionately greater number of CLABSIs in patients located in NHSN-defined surgical intensive care units. Similar trends with CAUTIs were noted, with progressive declines in catheter days, infections per 1,000 patient days, device utilization ratios, and SIRs (1.42 in 2016, 0.93 in 2017, 1.18 in 2018, and 0.78 in 2019) over the 4-year period. CONCLUSIONS Across an 11-hospital system, continuing efforts to reduce device utilization and infection rates resulted in declining SIRs for CLABSIs and CAUTIs. Hospitals with higher case-mix indices, and particularly level 1 trauma centers, had significantly higher central-line infection rates and SIRs.
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Luzum M, Sebolt J, Chopra V. Catheter-Associated Urinary Tract Infection, Clostridioides difficile Colitis, Central Line-Associated Bloodstream Infection, and Methicillin-Resistant Staphylococcus aureus. Med Clin North Am 2020; 104:663-679. [PMID: 32505259 DOI: 10.1016/j.mcna.2020.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hospital-acquired infections increase cost, morbidity, and mortality for patients across the United States and the world. Principal among these infections are central line-associated bloodstream infection, catheter-associated urinary tract infection, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus colonization and infections. This article provides succinct summaries of the background, epidemiology, diagnosis, and treatment of these conditions. In addition, novel prevention strategies, including those related to recent national interventions, are reviewed.
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Affiliation(s)
- Matthew Luzum
- The Division of Hospital Medicine, Department of Medicine, University of Michigan, 2800 Plymouth Road, Building 16 #432W, Ann Arbor, MI 48109, USA
| | - Jonathan Sebolt
- The Division of Hospital Medicine, Department of Medicine, University of Michigan, 2800 Plymouth Road, Building 16 #432W, Ann Arbor, MI 48109, USA
| | - Vineet Chopra
- The Division of Hospital Medicine, Department of Medicine, University of Michigan, 2800 Plymouth Road, Building 16 #432W, Ann Arbor, MI 48109, USA.
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