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

Abstract

ObjectiveTo identify, describe, and evaluate interventions to reduce unnecessary central venous catheter (CVC) use to prevent central-line–associated bloodstream infections (CLABSIs) in adults.DesignSystematic review.MethodsThe review has been registered in PROSPERO, an international prospective register of systematic reviews. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cumulative Index to Nursing and Allied Health (CINAHL) from inception until August 28, 2018, to collect experimental and observational studies. We included all studies that implemented interventions to reduce unnecessary CVC use, defined as interventions aimed at improving appropriateness, awareness of device presence, or prompt removal of devices.ResultsIn total, 1,892 unique citations were identified. Among them, 1 study (7.1%) was a randomized controlled trial, 9 studies (64.3%) were quasi-experimental studies, and 4 studies (28.6%) were cohort studies. Furthermore, 13 studies (92.9%) demonstrated a decrease in CVC use after intervention despite different reporting methods, and the reduction rate varied from 6.8% to 85%. Also, 7 studies (50.0%) that reported the incidence of CLABSI described a reduction in CLABSIs ranging from 24.4% to 100.0%. Data on secondary outcomes were limited, and results of the descriptive analysis showed 70%–84% compliance with these interventions, less catheter occlusion, shorter duration of hospitalization, and cost savings.ConclusionsInterventions to reduce unnecessary CVC use significantly decrease the rate of CLABSI. Healthcare providers should strongly consider implementing these interventions for prevention of CLABSI in adults.

Association of CLABSI With Hospital Length of Stay, Readmission Rates, and Mortality: A Retrospective Review

“…Central line-associated bloodstream infections (CLABSI) are deadly hospitalacquired infections (HAIs), with a reported mortality of 12-25% (Centers for Disease Control & Prevention [CDC], 2011). Although CLABSI is highly preventable through implementation of evidence-based interventions (Schreiber, Sax, Wolfensberger, Clack, & Kuster, 2018), CLABSI continues to rank among the most common HAIs (Xiong & Chen, 2018). CVCs are essential for the delivery of peripherally incompatible intravenous therapies, hemodynamic monitoring, and provision of dialysis and apheresis treatments (Alotaibi, Barri, & Elahi, 2020).…”

“…CLABSI-related excess LOS has been correlated with increased mortality and is estimated to be 13 days (Alotaibi et al, 2020). The cost associated with this excess LOS and associated treatment has been estimated at $32,000-$45,814 per CLABSI (Xiong & Chen, 2018). As health systems endeavor to achieve the ambitious goals of the Institute for Healthcare Improvement's (IHI, 2020) Triple Aim (i.e., improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care), it is imperative to understand the impact of CLABSI on outcomes and identify evidence-based strategies to improve the quality-of-care delivery.…”

“…The implementation of insertion and maintenance bundles are among the most frequently reported interventions to decrease CLABSI, and these bundles have resulted in significant decreases in infections (Xiong & Chen, 2018). Maintenance bundles focus on the removal of unnecessary central lines, as increased dwell time has been associated with increased risk for infection (Milstone et al, 2013).…”

“…Although the policy directs assessment of line necessity daily, appropriate indications for CVC are not clearly described. In the literature, rates of unnecessary or inappropriate CVCs range from 4.6% to 32.7%, and interventions aimed at reducing unnecessary placement and prompting early removal may be effective at curbing CVC use and subsequent CLABSI (Xiong & Chen, 2018). Evaluating the effectiveness of clearly defined indications for continuing need for CVC seems to be a promising opportunity for further study.…”

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

“…2,15 Following multicomponent interventions that stressed reducing device utilization and improving maintenance care, impressive initial declines in CLABSIs and CAUTIs can be achieved. [5][6][7][8][9][10]16 However, it appears with time the reductions reach a plateau, 5,13,14 and additional measures may be needed.…”