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Central Line–Associated Bloodstream Infection Reduction and Bundle Compliance in Intensive Care Units: A National Study

Published online by Cambridge University Press:  07 April 2016

E. Yoko Furuya
Affiliation:
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York NewYork-Presbyterian Hospital, New York, New York
Andrew W. Dick
Affiliation:
RAND Corporation, Boston, Massachusetts
Carolyn T. A. Herzig
Affiliation:
Center for Health Policy, Columbia University School of Nursing, New York, New York
Monika Pogorzelska-Maziarz
Affiliation:
Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania
Elaine L. Larson
Affiliation:
Center for Health Policy, Columbia University School of Nursing, New York, New York Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
Patricia W. Stone
Affiliation:
Center for Health Policy, Columbia University School of Nursing, New York, New York
Corresponding
E-mail address:

Abstract

OBJECTIVES

To describe compliance with the central line (CL) insertion bundle overall and with individual bundle elements in US adult intensive care units (ICUs) and to determine the relationship between bundle compliance and central line–associated bloodstream infection (CLABSI) rates.

DESIGN

Cross-sectional study.

PARTICIPANTS

National sample of adult ICUs participating in National Healthcare Safety Network (NHSN) surveillance.

METHODS

Hospitals were surveyed to determine compliance with CL insertion bundle elements in ICUs. Corresponding NHSN ICU CLABSI rates were obtained. Multivariate Poisson regression models were used to assess associations between CL bundle compliance and CLABSI rates, controlling for hospital and ICU characteristics.

RESULTS

A total of 984 adult ICUs in 632 hospitals were included. Most ICUs had CL bundle policies, but only 69% reported excellent compliance (≥95%) with at least 1 element. Lower CLABSI rates were associated with compliance with just 1 element (incidence rate ratio [IRR] 0.77; 95% confidence interval [CI], 0.64–0.92); however, ≥95% compliance with all 5 elements was associated with the greatest reduction (IRR, 0.67; 95% CI, 0.59–0.77). There was no association between CLABSI rates and simply having a written CL bundle policy nor with bundle compliance <75%. Additionally, better-resourced infection prevention departments were associated with lower CLABSI rates.

CONCLUSIONS

Our findings demonstrate the impact of transferring infection prevention interventions to the real-world setting. Compliance with the entire bundle was most effective, although excellent compliance with even 1 bundle element was associated with lower CLABSI rates. The variability in compliance across ICUs suggests that, at the national level, there is still room for improvement in CLABSI reduction.

Infect Control Hosp Epidemiol 2016;37:805–810

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122:160166.CrossRefGoogle Scholar
2. Perencevich, EN, Stone, PW, Wright, SB, et al. Raising standards while watching the bottom line: making a business case for infection control. Infect Control Hosp Epidemiol 2007;28:11211133.CrossRefGoogle ScholarPubMed
3. National and State Healthcare Associated Infections Progress Report. Centers for Disease Control and Prevention website. http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf. Published 2015. Accessed November 10, 2015.Google Scholar
4. Berwick, DM, Calkins, DR, McCannon, CJ, Hackbarth, AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006;295:324327.CrossRefGoogle Scholar
5. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.CrossRefGoogle ScholarPubMed
6. Render, ML, Hasselbeck, R, Freyberg, RW, et al. Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement. BMJ Qual Saf 2011;20:725732.CrossRefGoogle ScholarPubMed
7. Hospital National Patient Safety Goals. The Joint Commission website. http://www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf. Published 2015. Accessed November 12, 2015.Google Scholar
8. Furuya, EY, Dick, A, Perencevich, EN, Pogorzelska, M, Goldmann, D, Stone, PW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 2011;6:e15452.CrossRefGoogle Scholar
9. Stone, PW, Pogorzelska-Maziarz, M, Herzig, CT, et al. State of infection prevention in US hospitals enrolled in the National Health and Safety Network. Am J Infect Control 2014;42:9499.CrossRefGoogle Scholar
10. Resar, R, Griffin, FA, Haraden, C, Nolan, TW. Using Care Bundles to Improve Health Care Quality. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2012.Google Scholar
11. Resar, R, Pronovost, P, Haraden, C, Simmonds, T, Rainey, T, Nolan, T. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. J Qual Patient Saf 2005;31.Google ScholarPubMed
12. Bion, J, Richardson, A, Hibbert, P, et al. ‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England. BMJ Qual Saf 2013;22:110123.CrossRefGoogle ScholarPubMed
13. Koll, BS, Straub, TA, Jalon, HS, Block, R, Heller, KS, Ruiz, RE. The CLABs collaborative: a regionwide effort to improve the quality of care in hospitals. Jt Comm J Qual Patient Saf 2008;34:713723.CrossRefGoogle ScholarPubMed
14. Marsteller, JA, Sexton, JB, Hsu, YJ, et al. A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units. Crit Care Med 2012;40:29332939.CrossRefGoogle ScholarPubMed

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