Hospital-Wide Reduction in Central Line–Associated Bloodstream Infections: A Tale of Two Small Community Hospitals

Gozu, Aysegul; Clay, Colleen M; Younus, Faheem

doi:10.1086/660098

Cited by 22 publications

(11 citation statements)

References 9 publications

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“…The prevention and control of CVC-ABSIs has rarely been investigated outside the ICU setting, and to our knowledge, there is only one study conducted at two small community hospitals demonstrating 57% CVC infection rate reduction in non-ICU CVC-ABSIs, with the use of antibiotic impregnated catheters for some patients [12]. In this series the use of CVC, as we also reported, was higher in non-ICU setting, and considering that the vast majority of all hospitals are community hospitals with fewer than 200 beds, these results reinforce the necessity and importance of restoring measures of prevention and control in non-ICU inpatient [6,13].…”

Section: Discussionmentioning

confidence: 99%

“…Although a standard control group for comparison purposes was not feasible, the fact that a progressive and largely consistent increase in CVC-ABSIs rates from 1991 to 2008 and a decrease in CVC-ABSIs rates was observed for three years after starting the intervention programme, could support a cause and effect relationship between the beginning of a programme called “bacteremia zero” and a decrease in outside ICU CVC-ABSIs rates in Internal Medicine wards. The effects of this intervention and the increase in CVC-ABSIs rates during summertime reinforce the importance of allocating only trained and competent personnel for insertion and maintenance of central intravascular catheters, and ensuring appropriate nursing staff levels in non-ICU settings [2,12]. …”

Section: Discussionmentioning

confidence: 99%

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Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit

et al. 2013

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BackgroundOutside 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.MethodsFrom 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.ResultsPrevalence 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).ConclusionThe rate of CVC-ABSIs increased outside-ICU, and the implementation of multifaceted infection control programme decreased their clinical impact.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit

et al. 2013

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“…Multifaceted infection prevention programs integrating target DA-HAI surveillance methods were proved effective in several United States studies, which showed the occurrence of DA-HAI could be reduced by more than 30%, along with an analogous reduction in DA-HAI-related hospital costs[ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium’s findings

Yepez¹,

Bovera²,

Rosenthal³

et al. 2017

WJBC

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AIMTo report the results of the International Nosocomial Infection Control Consortium (INICC) study conducted in Quito, Ecuador.METHODSA 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.RESULTSWe 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.CONCLUSIONDA-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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“…In reviewing the US studies of 5 units demonstrating the greatest success in preventing CLABSI 56,62,65,78,83 and CAUTI, 28,34,66,134 several shared features emerged. Interventions that addressed multiple steps within the life cycle of a catheter (avoidance, insertion, maintenance, and removal) were common.…”

Section: Discussionmentioning

confidence: 99%

“…Study designs included 14 randomized controlled trials (RCTs) 48,64,68,74,79,[90][91][92][93][94][95][96][97][98] and 88 before-after studies (Appendix Table 1). 10,14,16,[24][25][26][27]33,[38][39][40][41][42][43][44][45][46][47][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][69][70][71][72]…”

Section: Characteristics Of Included Central Vascular Catheter Infectmentioning

confidence: 99%

Review of Strategies to Reduce Central Line‐Associated Bloodstream Infection (CLABSI) and Catheter‐Associated Urinary Tract Infection (CAUTI) in Adult ICUs

Patel

Gupta

Vaughn

et al. 2017

Journal of Hospital Medicine

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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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Hospital-Wide Reduction in Central Line–Associated Bloodstream Infections: A Tale of Two Small Community Hospitals

Cited by 22 publications

References 9 publications

Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit

Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit

Device-associated infection rates, mortality, length of stay and bacterial resistance in intensive care units in Ecuador: International Nosocomial Infection Control Consortium’s findings

Review of Strategies to Reduce Central Line‐Associated Bloodstream Infection (CLABSI) and Catheter‐Associated Urinary Tract Infection (CAUTI) in Adult ICUs

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