Mandated Self-reporting of Ventilator-Associated Pneumonia Bundle and Catheter-Related Bloodstream Infection Bundle Compliance and Infection Rates

Helmick, Ryan A.; Knofsky, Meredith L.; Braxton, Carla C.; Anuradha, S; Byers, Patricia; Lan, Charlie; Awad, Samir S.

doi:10.1001/jamasurg.2014.1627

Cited by 10 publications

(15 citation statements)

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“…The 47 studies that were included reported about the implementation of 49 care bundles. Thirteen studies described the implementation of the central line bundle [ 27 – 39 ], 27 studies described implementation of the ventilator bundle [ 10 , 16 , 35 , 39 – 63 ] and nine studies described the sepsis bundle implementation [ 64 – 72 ] (Additional file 3 ). Two studies reported the implementation of two bundles, i.e.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported the implementation of two bundles, i.e. both central line and ventilator bundle [ 35 , 39 ], and two studies were merged because they continued the implementation in the same hospital [ 60 , 61 ]. One study [ 50 ] reported detailed information about the study participants, i.e.…”

Section: Resultsmentioning

confidence: 99%

“…The composite measurement was reported in four studies [ 33 , 46 , 53 , 63 ]. Three studies [ 38 , 39 , 52 ] reported the lowest level of compliance, two studies [ 45 , 72 ] used the item-by-item measurement (Additional file 3 ) and in two studies the type of measurement was not clearly reported. In nine studies on the central line bundle implementation, the AON approach was reported to calculate the compliance levels.…”

Section: Resultsmentioning

confidence: 99%

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What are effective strategies for the implementation of care bundles on ICUs: a systematic review

2015

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BackgroundCare bundles have proven to be effective in improving clinical outcomes. It is not known which strategies are the most effective to implement care bundles. A systematic review was conducted to determine the strategies used to implement care bundles in adult intensive care units and to assess the effects of these strategies when implementing bundles.MethodsThe databases MEDLINE/PubMed, Ovid/Embase, CINAHL and CENTRAL were searched for eligible studies until January 31, 2015. Studies with (non)randomised designs on central line, ventilator or sepsis bundles were included if implementation strategies and bundle compliance were reported. Methodological quality was assessed by using the Downs and Black checklist. Data extraction and quality assessments were independently performed by two reviewers.ResultsIn total, 1533 records were screened and 47 studies were finally included. In 49 %, pre/post designs were used, 38 % prospective cohorts, and the remaining studies used retrospective designs (6 %), interrupted time series (4 %) and longitudinal designs (2 %). The methodological quality was classified as ‘fair’ in 77 %, and the remaining as ‘good’ (13 %) and ‘poor’ (11 %). The most frequently used strategies were education (86 %), reminders (71 %) and audit and feedback (63 %). Our results show that compliance is influenced by multiple factors, i.e. types and numbers of elements varied and different compliance measurements were reported. Furthermore, compliance was calculated within different time frames. Also, detailed information about compliance, such as numerators and denominators, was not reported. Therefore, recalculation of consistent monthly compliance levels was not possible.ConclusionsThe three most frequently used strategies were education, reminders and audit and feedback. We conclude that the heterogeneity among the included studies was high due to the variety in study designs, number and types of elements and types of compliance measurements. Due to the heterogeneity of the data and the poor quality of the studies, conclusions about which strategy results in the highest levels of bundle compliance could not be determined. We strongly recommend that studies in quality improvement should be reported in a formalised way in order to be able to compare research findings. It is imperative that authors follow the standards for quality improvement reporting excellence (SQUIRE) guidelines whenever they report quality improvement studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0306-1) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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What are effective strategies for the implementation of care bundles on ICUs: a systematic review

2015

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“…Adherence to the bundled care processes after the initial focused implementation efforts is often not maintained, or improved as in our study. Helmick and colleagues did report a small increase in compliance in ventilator-associated pneumonia and catheter-related bloodstream infection bundles after initial focused efforts to implement these into routine care [34]. Alternatively, Ferrer et al reported that adherence to a sepsis care bundle returned to baseline 1 year after a national education programme was ceased [35].…”

Section: Discussionmentioning

confidence: 99%

Inclusion of a care bundle for fever, hyperglycaemia and swallow management in a National Audit for acute stroke: evidence of upscale and spread

et al. 2019

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Background In the Quality in Acute Stroke Care (QASC) trial undertaken in stroke units (SUs) located in New South Wales (NSW), Australia (2005–2010), facilitated implementation of a nurse-led care bundle to manage fever, hyperglycaemia and swallowing (FeSS protocols) reduced death and disability for patients with stroke. We aimed to determine subsequent adherence to the bundled FeSS processes (reflective of the protocols) between 2013 and 2017 in Australian hospitals, and examine whether changes in adherence to these processes varied based on previous participation in the QASC trial or subsequent statewide scale-up (QASCIP—Quality in Acute Stroke Care Implementation Project) and presence of an SU. Methods Cross-sectional, observational study using self-reported organisational survey and retrospective clinical audit data from the National Acute Services Stroke Audit (2013, 2015, 2017). Mixed-effects logistic regression was performed with dependent variables: (1) composite outcome measure reflecting compliance with the FeSS protocols and (2) individual FeSS processes, including the year of audit as an independent variable, adjusted for correlation of outcomes within hospital. Separate models including interaction terms between the year of audit and previous participation in QASC/QASCIP and year of audit and SU were also generated. Results Hospital participation included the following: 2013—124 hospitals, 3741 cases; 2015—112 hospitals, 4087 cases; and 2017—117 hospitals, 4192 cases. An 80% increase in the odds of receiving the composite outcome in 2017 compared to 2013 was found (2013, 30%; 2017, 41%; OR 1.8; 95% CI 1.6, 2.0; p < 0.001). The odds of FeSS adherence from 2013 to 2017 was greater for hospitals that had participated in QASC/QASCIP relative to those that had not (participated OR 2.1; 95% CI 1.7, 2.7; not participated OR 1.6; 95% CI 1.4, 1.8; p = 0.03). Similar uptake in adherence was evident in hospitals with and without an SU between 2013 and 2017. Conclusion The use of the FeSS protocols within Australia increased from 2013 to 2017 with the inclusion of these care processes in the National Audit. Greater uptake in hospitals previously involved in QASC/QASCIP was evident. Our implementation methods may be useful for other national initiatives for improving access to evidence-based practice. Electronic supplementary material The online version of this article (10.1186/s13012-019-0934-y) contains supplementary material, which is available to authorized users.

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“…recently noted that “current mandated self-reported compliance and audit measures” are poorly correlated with “decreased catheter-related bloodstream infection. [ 4 ]”…”

mentioning

confidence: 99%

Catheter-related infections

Yasri¹,

Wiwanitkit

2015

Int J Crit Illn Inj Sci

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Mandated Self-reporting of Ventilator-Associated Pneumonia Bundle and Catheter-Related Bloodstream Infection Bundle Compliance and Infection Rates

Abstract: Current mandated self-reported compliance and audit measures are poorly correlated with decreased ventilator-associated pneumonia or catheter-related bloodstream infection.

Cited by 10 publications

References 30 publications

What are effective strategies for the implementation of care bundles on ICUs: a systematic review

What are effective strategies for the implementation of care bundles on ICUs: a systematic review

Inclusion of a care bundle for fever, hyperglycaemia and swallow management in a National Audit for acute stroke: evidence of upscale and spread

Catheter-related infections

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