Evidence-based practice to reduce central line infections (original) (raw)
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Critical Care Medicine, 2012
N early 250,000 healthcareassociated infections occur annually in patients with central lines placed to deliver life-saving medical care (1). Furthermore, 25% of patients contracting a central line-associated bloodstream infection (CLABSI) in the intensive care unit (ICU) die, totaling 31,000 deaths annually in the United States (2). A recent review estimated an added annual cost of $9 billion to the U.S. healthcare system (3). Previous quality improvement studies suggest that these infections are largely preventable (4-8). However, these studies were based on nonrandomized trials with historical or contemporaneous controls. These designs might overestimate the effect of the intervention and may not be sufficient to establish a causal relationship between the interventions and the reduced infections (9, 10), especially when a consistent national decline in CLABSIs was found in all types of ICUs in the United States over the same period (11). The Keystone ICU collaborative in Michigan (12) used a bundle of evidence-based bloodstream infection prevention practices coupled with a program to improve patient safety, communication, and teamwork, known as the Comprehensive Unit-based Safety Program (CUSP) (13). Together these interventions reduced the overall CLABSI rate by 66% in a cohort of ICUs (7). Nevertheless, this cohort study, with no concurrent control group, was not able to establish a causal relationship between the intervention and the reduced CLABSI rate. The rational next scientific step was to test a causal relationship between this multifaceted intervention and reduced CLABSI rates in a randomized controlled trial (RCT) to evaluate the magnitude of the effectiveness of the intervention. This article reports our findings. METHODS Design and Setting. We used a multicenter, phased, cluster RCT to implement and test the multifaceted intervention designed to improve safety, safety climate, and the use of evidencebased practices to prevent bloodstream infections. Two faith-based, affiliated health systems with hospitals in the West (Adventist Health) and in the Midwest and Southeast regions (Adventist Health System) of the country were
BMJ quality & safety, 2011
Elimination of hospital-acquired infections is an important patient safety goal. All 174 medical, cardiac, surgical and mixed Veterans Administration (VA) intensive care units (ICUs). A centralised infrastructure (Inpatient Evaluation Center (IPEC)) supported the practice bundle implementation (handwashing, maximal barriers, chlorhexidinegluconate site disinfection, avoidance of femoral catheterisation and timely removal) to reduce central line-associated bloodstream infections (CLABSI). Support included recruiting leadership, benchmarked feedback, learning tools and selective mentoring. Sites recorded the number of CLABSI, line days and audit results of bundle compliance on a secure website. CLABSI rates between years were compared with incidence rate ratios (IRRs) from a Poisson regression and with National Healthcare Safety Network referent rates (standardised infection ratio (SIR)). Pearson's correlation coefficient compared bundle adherence with CLABSI rates. Semi-structure...
Clinical Scholars Review, 2012
The growing concern for hospital-acquired infections in health care has stimulated the development of evidence-based practice (EBP) guidelines. Health care institutions across the United States are increas- ing their focus on the implementation of clinical practice guidelines using current EBP. Adherence to these guidelines by health care professionals is expected to improve the quality, equity, and efficiency of patient care.
BMJ, 2010
Objectives To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Design Collaborative cohort study to implement and evaluate interventions to improve patients' safety. Setting Intensive care units predominantly in Michigan, USA. Intervention Conceptual model aimed at improving clinicians' use of five evidence based recommendations to reduce rates of catheter related bloodstream infections rates, with measurement and feedback of infection rates. During the sustainability period, intensive care unit teams were instructed to integrate this intervention into staff orientation, collect monthly data from hospital infection control staff, and report infection rates to appropriate stakeholders. Main outcome measures Quarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19-36 months after implementation of the intervention). Results Ninety (87%) of the original 103 intensive care units participated, reporting 1532 intensive care unit months of data and 300 310 catheter days during the sustainability period. The mean and median rates of catheter related bloodstream infection decreased from 7.7 and 2.7 (interquartile range 0.6-4.8) at baseline to 1.3 and 0 (0-2.4) at 16-18 months and to 1.1 and 0 (0.0-1.2) at 34-36 months post-implementation. Multilevel regression analysis showed that incidence rate ratios decreased from 0.68 (95% confidence interval 0.53 to 0.88) at 0-3 months to 0.38 (0.26 to 0.56) at 16-18 months and 0.34 (0.24-0.48) at 34-36 months post-implementation. During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month post-implementation period (−1%, 95% confidence interval −9% to 7%).
Revista Latino-Americana de Enfermagem, 2016
Objective: to identify evidence-based care to prevent CLABSI among adult patients hospitalized in ICUs. Method: systematic review conducted in the following databases: PubMed, Scopus, Cinahl, Web of Science, Lilacs, Bdenf and Cochrane Studies addressing care and maintenance of central venous catheters, published from January 2011 to July 2014 were searched. The 34 studies identified were organized in an instrument and assessed by using the classification provided by the Joanna Briggs Institute. Results: the studies presented care bundles including elements such as hand hygiene and maximal barrier precautions; multidimensional programs and strategies such as impregnated catheters and bandages and the involvement of facilities in and commitment of staff to preventing infections. Conclusions: care bundles coupled with education and the commitment of both staff and institutions is a strategy that can contribute to decreased rates of central line-associated bloodstream infections among a...