A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital

Abstract

BackgroundWe propose that substituting central lines with midlines can help reduce the total number of central line catheter-days as well as central line-associated bloodstream infections (CLABSIs), thereby reducing the associated costs and the resulting increased length of stay. A midline or vascular access program in a community hospital can bring about these positive changes.ObjectivesOur objective is to evaluate whether the institution of a midline program for vascular access at a community hospital can reduce the number of central line catheter-days and the associated CLABSI rate, incidence, and cost.Materials and methodsWe collected data on the number of central line catheter-days per year starting from 2012. We also collected data on the total number of patient-days during this period and the number of CLABSIs. We started Centers for Disease Control and Prevention (CDC)-based recommendations to help decrease CLABSIs in June 2014; this included the use of the central venous catheters (CVC) insertion bundles and CVC maintenance bundle. Chlorhexidine baths were also given to all patients with central lines. In June 2015, we started a midline program and tracked data till June 2017. We then compared the infection rates during these periods.ResultsWe conclude that instituting CDC recommendations to decrease CLABSIs did bring down the CLABSI rate; this decrease was not statistically significant. However, the addition of the midline program to replace central lines whenever possible, combined with universal CDC recommendations, did result in a significant decrease in both the number of central line days per patient-day and the CLABSI rate.ConclusionWe recommend hospitals to develop a midline program to help reduce the use of central line catheters when possible to reduce the total number of catheter-days and the CLABSI rate associated with them.

Infection free midline catheter implementation at a community hospital (2 years)

“…The finding of zero Powerwand infections has been reported by other organizations as well. 5,8,14 Recent laboratory studies have demonstrated that the material this catheter is made of appears to resist bacterial adhesion and biofilm formation when compared to a standard polyurethane catheter. 15 This may, in part, explain the differences observed in our organization.…”

“…Others have reported various implementation strategies with favorable outcomes. [5][6][7][8][9] Each of the reports started with a clearly defined goal and patient population and quantified the impact of device implementation. Focuses included emergency room difficult access patients, surgical intensive care, as well as broader hospital implementation.…”

Managing central venous access during a health care crisis

“…Whereas central line teams and protocols for line placement and management have been described in the past, those efforts have been focused on reducing central line-associated bloodstream infections rather than on addressing a pressing need during a health care disaster. 11 , 12 , 13 Within the context of early isolated single-institution reports, we sought to provide a multi-institutional experience of line teams during the pandemic. The objective of this study was to describe the structure, practice patterns, and outcomes of these line teams on central venous access procedures and their related complications.…”

Adapting a vascular access service (VAS) to meet the needs of the COVID-19 pandemic

“…[7][8][9][10] Previous studies in non-COVID-19 patients have demonstrated that, when appropriate, opting for midline catheters rather than central lines decreases rates of BSI, especially in ventilated populations. 11,12 Further multicenter studies must be conducted to further characterize vascular access utilization in COVID-19 patients and explore whether such strategies would be applicable and successful in lowering the BSI rates of the COVID-19 patient population.…”