Impact of a Multidisciplinary Infection Prevention Initiative on Central Line and Urinary Catheter Utilization in a Long-term Acute Care Hospital

Abstract

BackgroundProlonged central line (CL) and urinary catheter (UC) use can increase risk of central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI).MethodsThis interventional study conducted in a 76-bed long-term acute care hospital (LTACH) in Southeast Michigan was divided into 3 periods: pre-intervention (January 2015–June 2015), intervention (July–November 2015), and postintervention (December 2015–March 2017). During the intervention period, a multidisciplinary infection prevention team (MIPT) made weekly recommendations to remove unnecessary CL/UC or switch to alternate urinary/intravenous access. Device utilization ratios (DURs) and infection rates were compared between the study periods. Interrupted time series (ITS) and 0-inflated poisson (ZIP) regression were used to analyze DUR and CLABSI/CAUTI data, respectively.ResultsUC-DUR was 31% in the pre- and postintervention periods and 21% in the intervention period. CL-DUR decreased from 46% (pre-intervention) to 39% (intervention) to 37% (postintervention). The results of ITS analysis indicated nonsignificant decrease and increase in level/trend in DURs coinciding with our intervention. The CAUTI rate per catheter-days did not decrease during intervention (4.36) compared with pre- (2.49) and postintervention (1.93). The CLABSI rate per catheter-days decreased by 73% during intervention (0.39) compared with pre-intervention (1.45). Rates again quadrupled postintervention (1.58). ZIP analysis indicated a beneficial effect of intervention on infection rates without reaching statistical significance.ConclusionsWe demonstrated that a workable MIPT initiative focusing on removal of unnecessary CL and UC can be easily implemented in an LTACH requiring minimal time and resources. A rebound increase in UC-DURs to pre-intervention levels after intervention end indicates that continued vigilance is required to maintain performance.

Interventions to reduce unnecessary central venous catheter use to prevent central-line–associated bloodstream infections in adults: A systematic review

“…The 14 included studies were published between 2010 and 2018 and were performed in the United States, [15][16][17][18][19][20][21][22][23][24] Canada, 25,26 France, 27 and Thailand. 28 Of the eligible studies, 1 (7.1%) was a cluster RCT, 28 4 (28.6%) were cohort studies, [22][23][24]26 and 9 (64.3%) were QESs, including 5 before-and-after QESs, 15,16,18,25,27 3 interrupted time-series studies, [19][20][21] and 1 pilot study. 17 These studies were all conducted in adult departments; all patients were ≥18 years old.…”

“…Only 2 studies included all inpatients and observation patients. 16,18 Most studies included only a specific department: 5 studies implemented the intervention in the medical and/or surgical wards, 19,20,23,25,28 2 studies were performed in the emergency departments, 22,24 and 5 studies focused on patients in intensive care units only. 15,17,21,26,27 Only 4 studies (28.6%) specified the type of CVC used.…”

“…Most studies reported sample size in terms of number of patients, ranging from 31 to 401,532 patients. 15,17,20,22,24,[26][27][28] Other studies reported only the patient days 16,25 or number of studied hospitals. 21 Another 3 studies did not specify the sample size.…”

“…The remaining 7 studies (50.0%) all implemented reminder interventions. 15,16,21,[25][26][27][28] Reminder formats included verbal reminders, written or printed reminders, and online reminders.…”

“…The only RCT included had a medium risk of bias due to random sequence generation and blinding of outcome assessment, but it did not include allocation concealment or blinding of participants. 28 Among the 9 QESs, 8 reported clear cause and effect, [15][16][17][19][20][21]25,27 5 included similar participants in comparisons, 15,17,[19][20][21] and all 9 reported participants that received similar treatments. However, only 1 study had a control group, 20 and 4 studies had multiple measurements of outcomes both before and after the intervention.…”