Compliance of Middle Eastern hospitals with the central line associated bloodstream infection prevention guidelines (original) (raw)
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Antimicrobial Resistance & Infection Control, 2016
Background: Central line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable. We documented attitudes and practices in intensive care units (ICUs) in 2015 in order to assess compliance with CLABSI prevention guidelines. Methods: Between June and October 2015, an online questionnaire was made available to medical doctors and nurses working in ICUs worldwide. We investigated practices related to central line (CL) insertion, maintenance and measurement of CLABSI-related data following the SHEA guidelines as a standard. We computed weighted estimates for high, middle and low-income countries using country population as a weight. Only countries providing at least 10 complete responses were included in these estimates. Results: Ninety five countries provided 3407 individual responses; no low income, 14 middle income (MIC) and 27 high income (HIC) countries provided 10 or more responses. Of the total respondents, 80% (MIC, SE = 1.5) and 81% (HIC, SE = 1.0) reported availability of written clinical guidelines for CLABSI prevention in their ICU; 23% (MIC,SE = 1.7) and 62% (HIC,SE = 1.4) reported compliance to the following (combined) recommendations for CL insertion: hand hygiene, full barrier precaution, chlorhexidine >0.5%, no topic or systemic antimicrobial prophylaxis; 60% (MIC,SE = 2.0) and 73% (HIC,SE = 1.2) reported daily assessment for the need of a central line. Most considered CLABSI measurement key to quality improvement, however few were able to report their CLABSI rate. Heterogeneity between countries was high and country specific results are made available. Conclusions: This study has identified areas for improvement in CLABSI prevention practices linked to CL insertion and maintenance. Priorities for intervention differ between countries.
American Journal of Infection Control, 2013
Background: "Zero" central line-associated bloodstream infections (CLABSI) have not been reported from Asian countries, which usually have predominance of difficult to curtail gram negative infections. It also remains unclear whether lowering CLABSI rates below National Healthcare Safety Network (NHSN) benchmarks in such countries is even possible. In this study, we evaluated effects of a quality improvement initiative to achieve "Zero CLABSI" in our intensive care unit. Methods: A root cause analysis in February 2010 identified problems with clinical practice, environment, and products. Extensive education sessions were followed by implementation of strategies in the form of "itemized" bundles derived from practice guidelines, with complete enforcement starting August 2010. Results were benchmarked against NHSN data. Data were analyzed in a preintervention (1 year) and postintervention (2 years) fashion, using Poisson regression analysis to generate incidence-rate ratio (IRR). Results: In the preintervention period, CLABSI rate was 6.9/1,000 catheter-days (CDs) (35 CLABSI/5,083 CDs). In the postintervention year 1, rate was 1.06/1,000 CDs (4 CLABSI/3,787 CDs) with IRR of 0.15 (95% confidence interval: 0.04-0.44, P < .001) and reduction of 85%. In postintervention year 2, rate was 0.35/ 1,000 CDs (1/2,860 CDs) with IRR of 0.05 (95% confidence interval: 0.001-0.31, P < .001). There was a period of "Zero CLABSI" for 15 consecutive months, surpassing NHSN benchmarks. Conclusion: : CLABSIs can be eliminated in any intensive care unit regardless of the location and type of organism. NHSN data should be a realistic CLABSI benchmarking target for developing countries.
Prevention of Central Line-Associated Bloodstream Infection via Quality Improvement
IJSR, Vol (2), No (11), November 2023, 2023
Introduction: The economic burden of CLABSIs is substantial, with each infection estimated to add between 45,000to45,000 to 45,000to55,000 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.
CLABSI Catheter-associated bloodstream infection prevention: What is Missing?
The most frequent invasive procedure performed by nurses in acute care is venous access with 80% o f patients in the USA, 60% of patients in the UK, and 33-67% of patients in Australia requiring intravenous access (Lavery, 2005; Hadaway, 2012; Wallis, 2014). Not only are vascular access devices the primary avenue for treatment administration, but many patients receive multiple intravenous medications and have more than one vascular access device (VAD). High usage of VADs, both central and peripheral, is not w ithout risk of infection or other complications. Concerns regarding catheter-associated bloodstream infections are common with a general focus on central venous access devices (CVAD). Prevention for central line associated bloodstream infections (CLABSI) is concentrated on compliance with the five components of the central line bundle with variable success (Pronovost, 2006; Blot, 2014; Hsu, 2014). Preventive efforts and the application of new safety devices have resulted in actual cost reductions in addition to creating greater patient safety, reduced morbidity and mortality as well as an improved turnover of acute care bed space. Despite these worldwide efforts and general percentage reductions in infection over the past five years, more than 800 medium and large hospitals in the USA continue to have high CLABSI rates as do countless other hospitals throughout the world (Wise, 2013; Herzer, 2014).
Eliminating Infections in the ICU: CLABSI
Current Infectious Disease Reports, 2015
Central line-associated bloodstream infections (CLABSI) are one of the leading causes of death in the USA and around the world. As a preventable healthcare-associated infection, they are associated with significant morbidity and excess costs to the healthcare system. Effective and long-term CLABSI prevention requires a multifaceted approach, involving evidencebased best practices coupled with effective implementation strategies. Currently recommended practices are supported by evidence and are simple, such as appropriate hand hygiene, use of full barrier precautions, avoidance of femoral lines, skin antisepsis, and removal of unnecessary lines. The most successful and sustained improvements in CLABSI rates further utilize an adaptive component to align provider behaviors with consistent and reliable use of evidence-based practices. Great success has been achieved in reducing CLABSI rates in the USA and elsewhere over the past decade, but more is needed. This article aims to review the initiatives undertaken to reduce CLABSI and summarizes the sentinel and recent literature regarding CLABSI and its prevention.
APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI)
Antimicrobial resistance and infection control, 2016
This document is an executive summary of the APSIC Guide for Prevention of Central Line Associated Bloodstream Infections (CLABSI). It describes key evidence-based care components of the Central Line Insertion and Maintenance Bundles and its implementation using the quality improvement methodology, namely the Plan-Do-Study-Act (PDSA) methodology involving multidisciplinary process and stakeholders. Monitoring of improvement over time with timely feedback to stakeholders is a key component to ensure the success of implementing best practices. A surveillance program is recommended to monitor outcomes and adherence to evidence-based central line insertion and maintenance practices (compliance rate) and identify quality improvement opportunities and strategically targeting interventions for the reduction of CLABSI.
Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days
Current Infectious Disease Reports, 2021
Purpose of Review While reducing unnecessary days present of central venous catheters (CVCs) is part of central line associated bloodstream infection (CLABSI) best practices, there is limited information regarding compliance with this recommendation as well as addressing barriers to compliance. Recent Findings Significant work has been directed towards daily audits of necessity and improving communication between members of the medical team. Other critical interventions include utilization of the electronic health record (EHR), leadership support of CLABSI reduction goals, and avoiding CVC placement over more appropriate vascular access. Summary Institutions have varied approaches to addressing the issue of removing idle CVCs, and more standardized approaches in checklists as well as communication, particularly on multidisciplinary rounds, will be key to CVC removal. Utilization of the EHR for reminders or appropriate documentation of necessity is a factor. Avoidance of placing a CVC or appropriateness of the CVC is also important to consider. Keywords Central line associated bloodstream infections • Infection prevention • Central line days • Midline catheters This article is part of the Topical Collection on Healthcare Associated Infections
Current Infectious Disease Reports, 2011
Central line–associated blood stream infections (CLABSI) are among the most common, lethal, and costly health care–associated infections. Recent large collaborative quality improvement efforts have achieved unprecedented and sustained reductions in CLABSI rates and demonstrate that these infections are largely preventable, even for exceedingly ill patients. The broad acceptance that zero CLABSI rates are an achievable goal has motivated and stimulated