Decreasing Central Line–Associated Bloodstream Infections in the Non-ICU Population

Medina, Alma; Serratt, Teresa; Pelter, Michele M.; Brancamp, Tami U.

doi:10.1097/ncq.0000000000000034

Cited by 15 publications

(6 citation statements)

References 26 publications

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“…Our study differs from others in two main ways; first, in how strategies were determined and secondly, in how compliance was measured. Many previous studies have sought to improve compliance with CHG bathing to decrease CLABSI rates [18,34,35]. Reynolds and colleague s [17] implemented CHG bathing in a neurosurgical ICU setting through using educational outreach visits, audit and feedback, printed educational materials, and local opinion leaders.…”

Section: Audit and Feedback And Educational Outreach Implementation Strategiesmentioning

confidence: 99%

“…This article provided details on how strategies were identified and details for how they were operationalized [17]. However, many other articles do not tailor strategies to determinants, and lack the details needed to replicate the implementation strategies [18,34,35]. Providing this detail is a noted deficit in implementation science literature, with Proctor and colleagues noting that implementation strategies are inconsistently labeled, poorly justified, and rarely described in detail [36].…”

Section: Audit and Feedback And Educational Outreach Implementation Strategiesmentioning

confidence: 99%

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Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial

et al. 2021

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Background Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor. The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff’s compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff’s knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates. Methods A stepped wedged cluster-randomized design was used with units clustered into 4 sequences; each sequence consecutively began the intervention over the course of 4 months. The Grol and Wensing Model of Implementation helped guide selection of the implementation strategies, which included educational outreach visits and audit and feedback. Compliance with the appropriate CHG bathing process and daily CHG bathing documentation were assessed. Outcomes were assessed 12 months after the intervention to assess for sustainability. Results Among the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff’s knowledge and perceptions of CHG bathing significantly improved after the intervention (p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates. Conclusions Using educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices. Trial registration ClinicalTrials.gov, NCT03898115, Registered 28 March 2019.

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Section: Audit and Feedback And Educational Outreach Implementation Strategiesmentioning

confidence: 99%

Section: Audit and Feedback And Educational Outreach Implementation Strategiesmentioning

confidence: 99%

Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial

et al. 2021

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“…In most studies, a higher-ranking, responsible multidisciplinary team [ 1 ], [ 3 ], [ 5 ], [ 6 ], [ 8 ], [ 10 ], [ 11 ], [ 16 ], [ 17 ], [ 18 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 25 ] of up to 20 members [ 26 ] effected the implementation. Ting et al [ 42 ] and Kilbride et al [ 53 ] preferred implementing preventive measures in manageable “plan-do-check-act” cycles [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…To merge single measures e.g. from national guidelines into an individual bundle for each hospital may lead to a significant improvement in treatment quality in the long term [ 16 ], [ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ], [ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ], [ 33 ], [ 34 ], [ 35 ], [ 36 ], [ 37 ], [ 38 ].…”

Section: Introductionmentioning

confidence: 99%

Preventive bundles to reduce catheter-associated bloodstream infections in neonatal intensive care

Schmid

Geffers

Wagenpfeil³

et al. 2018

GMS Hygiene and Infection Control; 13:Doc10

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“…In this group, most articles (14, 90.9%) measured process compliance with HAI prevention bundles (e.g., CLABSI, VAP, MRSA screening adherence) [62,63,72,73,75,87,88,90,93,[105][106][107][108][109] or hand hygiene adherence [110][111][112][113] or adherence to policy and guidelines [76,78,114]. Regarding HAIs, most (n = 17, 81.8%) measured CLABSIs, CAUTIs, VAPs, or SSIs either exclusively or as a combined outcome [62,63,72,73,75,76,78,87,88,90,93,[105][106][107][108][109][110]113]. Of note, C. difficile was only explored as an outcome by two [63, Single time measurement of safety culture Nurses were the only respondents for culture measurement Unique in that tailored unit-level intervention designed to improve safety culture (rather than clinical outcomes)…”

Section: Outcomes Of Interest: Ipc Processes Of Care and Haismentioning

confidence: 99%

Culture of Safety: Impact on Improvement in Infection Prevention Process and Outcomes

Braun

Chitavi

Suzuki

et al. 2020

Curr Infect Dis Rep

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Purpose Safety culture is known to be related to a wide range of outcomes, and measurement of safety culture is now required for many hospitals in the U.S.A. In previous reviews, the association with outcomes has been limited by the research design and strength of the evidence. The goal of this review was to examine recent literature on the relationship between safety culture and infection prevention and control-related (IPC) processes and healthcare-associated infections (HAIs) in U.S. healthcare organizations. We also sought to quantitatively characterize the challenges to empirically establishing these relationships and limitations of current research. Recent Findings A PubMed search for U.S. articles published 2009–2019 on the topics of infection prevention, HAIs, and safety culture yielded 448 abstracts. After screening, 55 articles were abstracted for information on purpose, measurement, analysis, and conclusions drawn about the role of safety culture in the outcome. Approximately ½ were quality improvement (QI) initiatives and ½ were research studies. Overall, 51 (92.7%) concluded there was an association between safety culture and IPC processes or HAIs. However, only 39 studies measured safety culture and 26 statistically analyzed safety culture data for associations. Though fewer QI initiatives analyzed associations, a higher proportion concluded an association exists than among research studies. Summary Despite limited empirical evidence and methodologic challenges to establishing associations, most articles supported a positive relationship between safety culture, improvement in IPC processes, and decreases in HAIs. Authors frequently reported experiencing improvements in safety culture when not directly measured. The findings suggest that associations between improvement and safety culture may be bi-directional such that positive safety culture contributes to successful interventions and implementing effective interventions drives improvements in culture. Greater attention to article purpose, design, and analysis is needed to confirm these presumptive relationships.

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Decreasing Central Line–Associated Bloodstream Infections in the Non-ICU Population

Cited by 15 publications

References 26 publications

Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial

Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial

Preventive bundles to reduce catheter-associated bloodstream infections in neonatal intensive care

Culture of Safety: Impact on Improvement in Infection Prevention Process and Outcomes

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