An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU

School of Medicine, Johns Hopkins University, Baltimore, USA
New England Journal of Medicine (Impact Factor: 55.87). 12/2006; 355(26):2725-32. DOI: 10.1056/NEJMoa061115
Source: PubMed


Catheter-related bloodstream infections occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.
We conducted a collaborative cohort study predominantly in ICUs in Michigan. An evidence-based intervention was used to reduce the incidence of catheter-related bloodstream infections. Multilevel Poisson regression modeling was used to compare infection rates before, during, and up to 18 months after implementation of the study intervention. Rates of infection per 1000 catheter-days were measured at 3-month intervals, according to the guidelines of the National Nosocomial Infections Surveillance System.
A total of 108 ICUs agreed to participate in the study, and 103 reported data. The analysis included 1981 ICU-months of data and 375,757 catheter-days. The median rate of catheter-related bloodstream infection per 1000 catheter-days decreased from 2.7 infections at baseline to 0 at 3 months after implementation of the study intervention (P< or =0.002), and the mean rate per 1000 catheter-days decreased from 7.7 at baseline to 1.4 at 16 to 18 months of follow-up (P<0.002). The regression model showed a significant decrease in infection rates from baseline, with incidence-rate ratios continuously decreasing from 0.62 (95% confidence interval [CI], 0.47 to 0.81) at 0 to 3 months after implementation of the intervention to 0.34 (95% CI, 0.23 to 0.50) at 16 to 18 months.
An evidence-based intervention resulted in a large and sustained reduction (up to 66%) in rates of catheter-related bloodstream infection that was maintained throughout the 18-month study period.

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    • "Reduction in health care infections and especially CRBSIs has been the goal of many quality improvement programmes internationally and within the UK (Marsteller et al., 2012; McPeake et al., 2012; Bion et al., 2013; Palomar et al., 2013). It has been repeatedly demonstrated, that robust education and implementation of a bundle approach can significantly reduce the incidence of these potentially deadly infections (Pronovost et al., 2006; Munoz-Price et al., 2012; Bion et al., 2013). In our series, we could demonstrate that such lasting effects are possible in a non-academic centre. "
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    ABSTRACT: Health care associated infections are a major contributor to avoidable harm experienced by patients in modern health care settings. Recent reports suggest that electronic checklists for the documentation of a central line bundle may significantly enhance documented process compliance and help to reduce catheter-related bloodstream infection rates. This paper describes the use of our electronic tool to monitor and feedback process compliance in conjunction of introducing bespoke central line insertion packs to tackle catheter-related bloodstream infections in our intensive care unit in a medium-sized district general hospital. Continuous quality improvement programme with 'Plan-Do-Study-Act' cycles was implemented. The central venous catheter insertion and maintenance bundle was rolled out in 2007. To monitor compliance with the bundle elements, an electronic tool was designed as part of our bedside Clinical Information System. From 2009, regular quarterly feedback was provided on the number of central venous catheter lines inserted, compliance with the insertion and maintenance bundle and catheter-related bloodstream infection rate using the data collected through the Clinical Information System. We have also introduced dedicated line insertion trolleys and factory-prepared insertion packs. We used segmented regression analysis to assess the changes in the catheter-related bloodstream infection rate before and after implementation of the central venous catheter bundle. Bundle compliance increased during the implementation period and reached over 95% within 6 months. We observed a significant reduction in the catheter-related bloodstream infection rate from 15·6/1000 days to 0·4/1000 days. Regression analysis showed that only the compliance had significant effect on the number and prevalence of catheter-related bloodstream infections. Implementation of evidence-based care bundles reinforced by real-time feedback on the performance of caregivers can significantly reduce the rate of catheter-related bloodstream infection in the intensive care unit. Ensuring that change processes are seamlessly integrated in the workflow with minimal administrative burden is crucial to the quality improvement process. © 2015 British Association of Critical Care Nurses.
    Nursing in Critical Care 05/2015; 20(4). DOI:10.1111/nicc.12186 · 0.65 Impact Factor
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    • "To provide care that is safe, effective and efficient, and meets the multiple needs of patients, healthcare systems are in great need of redesign (Institute of Medicine Committee on Quality of Health Care in America 2001). Considerable efforts and substantial resources have been invested in the past decade to prevent medical errors and improve patient safety (Bates et al. 1999; Landrigan et al. 2004; Pronovost et al. 2006); however, evidence on the effectiveness of these efforts is ambiguous and limited (Landrigan et al. 2010; Leape and Berwick 2005; Shekelle et al. 2011; Vincent et al. 2008). The 2005 report by the IOM and the National Academy of Engineering highlighted human factors and ergonomics (HFE) as a key systems engineering approach to improve healthcare work systems and processes and, therefore, quality of care and patient safety (Reid et al. 2005). "
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    ABSTRACT: Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.
    Ergonomics 01/2015; 58(1):33-49. DOI:10.1080/00140139.2014.959070 · 1.56 Impact Factor
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    • "Recent studies have shown that this serious complication could result in increasing mortality, morbidity and hospital stay length [1-6]. Therefore, several evidence-based interventions, including the use of chlorhexidine gluconate (CHG) skin preparations and maximal sterile barriers during insertion, use of the subclavian or internal jugular vein instead of the femoral vein, hand hygiene, and daily review of line necessity, were developed to prevent CLABSI [7-10]. Moreover, these strategies were compiled into a “central line bundle” by the Institute for Healthcare Improvement (IHI). "
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    ABSTRACT: Background Knowledge about the impact of each central line insertion bundle on central line-associated bloodstream infection (CLABSI) is limited. Methods A quality-improvement intervention, including education, central venous catheter (CVC) insertion bundle, process and outcome surveillance, have been introduced since March 2013. Outcome surveillances, including CLABSI per 1,000 catheter-days, CLABSI per 1,000 inpatient-days, and catheter utilization rates (days of catheter use divided by total inpatient-days), were measured. As a baseline measurement for a comparison, we retrospectively collected data from March 1, 2012 to December 31, 2012. Results During this 10-month period, there were a total of 687 CVC insertions, and 627 (91.2%) insertions were performed by intensivists. The rate of CLABSI significantly declined from 1.65 per 1000 catheter-day during the pre-intervention period to 0.65 per 1000 catheter-day post-intervention period (P = 0.039). CLABSI more likely developed in subjects in which a maximal sterile barrier was not used compared with subjects in which it was used (P = 0.03). Moreover, CVC inserted by non-intensivists were more likely to become infected than CVC inserted by intensivists (P = 0.010). Conclusions This multidisciplinary infection control intervention, including a central line insertion care bundle, can effectively reduce the rate of CLABSI. The impact of different care bundle varies, and a maximal sterile barrier precaution during catheter insertion is an essential component of the care line insertion bundle.
    BMC Infectious Diseases 07/2014; 14(1):356. DOI:10.1186/1471-2334-14-356 · 2.61 Impact Factor
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