Prevention of Central Line-Associated Bloodstream Infection via Quality Improvement
DOI:
https://doi.org/10.59992/IJSR.2023.v2n11p17Keywords:
Infection, Intervention, Efficacy, Bacteria, Central-line, BloodAbstract
Introduction: The economic burden of CLABSIs is substantial, with each infection estimated to add between $45,000 to $55,000 to hospital costs. The aim of this systematic review was to synthesize the current evidence on the prevention of CLABSI through quality improvement initiatives.
Methods: A literature search was conducted using the following electronic databases: PubMed, MEDLINE, CINAHL, Cochrane Library, and EMBASE. The search was limited to studies published in the last 15 years, to ensure the relevance and timeliness of the data. The inclusion criteria were strictly defined to select high-quality interventional studies. Included studies were those that focused on interventions for the prevention of CLABSI and were conducted in hospital settings. Studies were excluded if they were non-interventional (such as reviews, editorials, and opinion pieces), focused on populations outside of hospital settings, or did not provide clear outcome measures related to CLABSI rates.
Results: A number of 8 studies were included with a common theme among the interventions was the implementation of comprehensive care bundles, which included components like staff education, hand hygiene protocols, and standardized catheter maintenance procedures. Comprehensive care bundles were particularly effective, with risk ratios (RRs) as low as 0.20 and 0.21, highlighting a reduction in infection rates by approximately 80%. Interventions involving antimicrobial catheters showed RRs ranging from 0.33 to 0.71, indicating a substantial decrease in CLABSI incidences. Moreover, staff training and education interventions resulted in RRs between 0.36 and 0.46, underscoring their importance in infection control.
Conclusions: The review revealed a broad range of sample sizes and methodologies, underscore the critical role of multifaceted, context-specific approaches in significantly reducing the incidence of CLABSIs and improving patient safety in hospital settings.
References
1. Centers for Disease Control and Prevention. Central line–associated bloodstream infection (CLABSI) event protocol, 2014: 1–10.
2. Centers for Disease Control and Prevention. NHSN key terms. Atlanta, GA: CDC, 2014: 1–16.
3. Blot SI, Depuydt P, Annemans L, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005; 41:1591–8.
4. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011; 32:101–14.
5. Rosenthal VD. Central line–associated bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis 2009; 49:1899–907.
6. Olaechea PM, Palomar M, Álvarez-Lerma F, et al. Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients. Rev Esp Quimioter 2013; 26:21–9.
7. Januel JM, Harbarth S, Allard R, et al. Estimating attributable mortality due to nosocomial infections acquired in intensive care units. Infect Control Hosp Epidemiol 2010; 31:388–94.
8. Marra AR, Cal RG, Durao MS, et al. Impact of a program to prevent central line-associated bloodstream infection in the zero-tolerance era. Am J Infect Control 2010; 38:434–9.
9. Pronovost PJ, Goeschel CA, Colantuoni E, et al. Sustaining reductions in catheter-related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010; 340:c309.
10. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52:e162–93.
11. Yokoe DS, Mermel LA, Anderson DJ, et al. Executive summary: a compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008; 29:S12–21.
12. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006; 81:1159–71.
13. Blot S, Vandijck D, Vogelaers D, Labeau S. Bridging the gap between theory and practice. ICU Management 2011; 11:40–11.
14. Labeau SO, Vandijck DM, Rello J, et al. Centers for Disease Control and Prevention guidelines for preventing central venous catheter-related infection: results of a knowledge test among 3405 European intensive care nurses. Crit Care Med 2009; 37:320–23.
15. Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282:1458–65.
16. Ranji SR, Shetty K, Posley KA, et al. Closing the quality gap: a critical analysis of quality improvement strategies. Vol 6: Prevention of healthcare–associated infections. Rockville, MD: Agency for Healthcare Research and Quality, 2007.
17. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998; 52:377–84.
18. Fraher MH, Collins CJ, Bourke J, Phelan D, Lynch M. Cost-effectiveness of employing a total parenteral nutrition surveillance nurse for the prevention of catheter-related bloodstream infections. J Hosp Infect 2009; 73:129–34.
19. Flodgren G, Conterno LO,Mayhew A, Omar O, Pereira CR, Shepperd S. Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database Syst Rev 2013. doi:10.1002/14651858.CD006559.pub2.
20. Coopersmith CM, Rebmann TL, Zack JE, et al. Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit. Crit Care Med 2002; 30:59–64.
21. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355:2725–32.
22. Coopersmith CM, Zack JE, Ward MR, et al. The impact of bedside behavior on catheter-related bacteremia in the intensive care unit. Arch Surg 2004; 139:131–6.
23. Richardson J, Tjoelker R. Beyond the central line-associated bloodstream infection bundle: the value of the clinical nurse specialist in continuing evidence-based practice changes. Clin Nurse Spec 2012; 26:205–11.
24. Rosenthal VD, Maki DG, Rodrigues C, et al. Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central line–associated bloodstream infection rates in intensive care units of 15 developing countries. Infect Control Hosp Epidemiol 2010; 31:67–72.
25. Berenholtz SM, Pronovost PJ, Lipsett PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004; 32:2014–20.
26. Cherry-Bukowiec JR, Denchev K, Dickinson S, et al. Prevention of catheter-related bloodstream infection: back to basics? Surg Infect (Larchmt) 2011; 12:27–32.
27. Longmate AG, Ellis KS, Boyle L, et al. Elimination of central-venous catheter- related bloodstream infections from the intensive care unit. BMJ Qual Saf 2011; 20:174–80.
