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A Central Line Care Maintenance Bundle for the Prevention of Central Line–Associated Bloodstream Infection in Non–Intensive Care Unit Settings

  • Caroline O’Neil (a1), Kelly Ball (a1), Helen Wood (a2), Kathleen McMullen (a2), Pamala Kremer (a2), S. Reza Jafarzadeh (a1), Victoria Fraser (a1) and David Warren (a1)...

Abstract

OBJECTIVE

To evaluate a central line care maintenance bundle to reduce central line–associated bloodstream infection (CLABSI) in non–intensive care unit settings.

DESIGN

Before-after trial with 12-month follow-up period.

SETTING

A 1,250-bed teaching hospital.

PARTICIPANTS

Patients with central lines on 8 general medicine wards. Four wards received the intervention and 4 served as controls.

INTERVENTION

A multifaceted catheter care maintenance bundle consisting of educational programs for nurses, update of hospital policies, visual aids, a competency assessment, process monitoring, regular progress reports, and consolidation of supplies necessary for catheter maintenance.

RESULTS

Data were collected for 25,542 catheter-days including 43 CLABSI (rate, 1.68 per 1,000 catheter-days) and 4,012 catheter dressing observations. Following the intervention, a 2.5% monthly decrease in the CLABSI incidence density was observed on intervention floors but this was not statistically significant (95% CI, −5.3% to 0.4%). On control floors, there was a smaller but marginally significant decrease in CLABSI incidence during the study (change in monthly rate, −1.1%; 95% CI, −2.1% to −0.1%). Implementation of the bundle was associated with improvement in catheter dressing compliance on intervention wards (78.8% compliance before intervention vs 87.9% during intervention/follow-up; P<.001) but improvement was also observed on control wards (84.9% compliance before intervention vs 90.9% during intervention/follow-up; P=.001).

CONCLUSIONS

A multifaceted program to improve catheter care was associated with improvement in catheter dressing care but no change in CLABSI rates. Additional study is needed to determine strategies to prevent CLABSI in non–intensive care unit patients.

Infect Control Hosp Epidemiol 2016;37:692–698

Copyright

Corresponding author

Address correspondence to Caroline O’Neil, MA, MPH, Campus Box 8051, 660 S. Euclid Ave, St. Louis, MO 63110 (coneil@dom.wustl.edu).

References

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1. Han, Z, Liang, SY, Marschall, J. Current strategies for the prevention and management of central line-associated bloodstream infections. Infect Drug Resist 2010;3:147163.
2. Whited, A, Lowe, JM. Central line-associated bloodstream infection: not just an intensive care unit problem. Clin J Oncol Nurs 2013;17:2124.
3. Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60:243248.
4. O’Grady, NP, Alexander, M, Burns, LA, et al. Summary of recommendations: guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:10871099.
5. Climo, M, Diekema, D, Warren, DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003;24:942945.
6. Trick, WE, Vernon, MO, Welbel, SF, Wisniewski, MF, Jernigan, JA, Weinstein, RA. Unnecessary use of central venous catheters: the need to look outside the intensive care unit. Infect Control Hosp Epidemiol 2004;25:266268.
7. Ajenjo, MC, Morley, JC, Russo, AJ, et al. Peripherally inserted central venous catheter-associated bloodstream infections in hospitalized adult patients. Infect Control Hosp Epidemiol 2011;32:125130.
8. Kallen, AJ, Patel, PR, O’Grady, NP. Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Clin Infect Dis 2010;51:335341.
9. Memish, ZA, Arabi, Y, Cunningham, G, et al. Comparison of US and non-US central venous catheter infection rates: evaluation of processes and indicators in infection control study. Am J Infect Control 2003;31:237242.
10. Marschall, J, Leone, C, Jones, M, Nihill, D, Fraser, VJ, Warren, DK. Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study. Infect Control Hosp Epidemiol 2007;28:905909.
11. Wischnewski, N, Kampf, G, Gastmeier, P, et al. Prevalence of primary bloodstream infections in representative German hospitals and their association with central and peripheral vascular catheters. Zentralbl Bakteriol 1998;287:93103.
12. Vonberg, RP, Behnke, M, Geffers, C, et al. Device-associated infection rates for non-intensive care unit patients. Infect Control Hosp Epidemiol 2006;27:357361.
13. Zingg, W, Sax, H, Inan, C, et al. Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected. J Hosp Infect 2009;73:4146.
14. Trick, WE, Miranda, J, Evans, AT, Charles-Damte, M, Reilly, BM, Clarke, P. Prospective cohort study of central venous catheters among internal medicine ward patients. Am J Infect Control 2006;34:636641.
15. Chopra, V, Krein, SL, Olmsted, RN, Safdar, N, Saint, S. Prevention of central line-associated bloodstream infections: brief update review. In: Shekelle PG, Wachter RM, Pronovost PJ; US Agency for Healthcare Research and Quality (AHRQ), eds. Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville, MD: AHRQ; 2013:88109.
16. O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e162e193.
17. Marschall, J, Mermel, LA, Classen, D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29:S22S30.
18. 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;30:5964.
19. 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;139:131136.
20. Eggimann, P, Harbarth, S, Constantin, MN, Touveneau, S, Chevrolet, JC, Pittet, D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000;355:18641868.
21. Fakih, MG, Jones, K, Rey, JE, et al. Sustained improvements in peripheral venous catheter care in non-intensive care units: a quasi-experimental controlled study of education and feedback. Infect Control Hosp Epidemiol 2012;33:449455.
22. Santana, SL, Furtado, GH, Wey, SB, Medeiros, EA. Impact of an education program on the incidence of central line-associated bloodstream infection in 2 medical-surgical intensive care units in Brazil. Infect Control Hosp Epidemiol 2008;29:11711173.
23. Shedlarski, A, White-Williams, C. Research rounds: an evidence-based project to decrease catheter-related bloodstream infections. Nurs Crit Care 2013;8:3943.
24. Warren, DK, Zack, JE, Mayfield, JL, et al. The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU. Chest 2004;126:16121618.
25. Woeltje, KF, McMullen, KM, Butler, AM, Goris, AJ, Doherty, JA. Electronic surveillance for healthcare-associated central line-associated bloodstream infections outside the intensive care unit. Infect Control Hosp Epidemiol 2011;32:10861090.
26. Frasca, D, Dahyot-Fizelier, C, Mimoz, O. Prevention of central venous catheter-related infection in the intensive care unit. Crit Care 2010;14:212.
27. Hyndman, RJ, Athanasopoulos, G. Forecasting: Principles and Practice. OTexts, 2013.
28. Rupp, ME, Cassling, K, Faber, H, et al. Hospital-wide assessment of compliance with central venous catheter dressing recommendations. Am J Infect Control 2013;41:8991.
29. Shapey, IM, Foster, MA, Whitehouse, T, Jumaa, P, Bion, JF. Central venous catheter-related bloodstream infections: improving post-insertion catheter care. J Hosp Infect 2009;71:117122.
30. Zingg, W, Imhof, A, Maggiorini, M, Stocker, R, Keller, E, Ruef, C. Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Crit Care Med 2009;37:21672173.
31. Lissauer, ME, Leekha, S, Preas, MA, Thom, KA, Johnson, SB. Risk factors for central line-associated bloodstream infections in the era of best practice. J Trauma Acute Care Surg 2012;72:11741180.
32. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122:160166.
33. Fagan, RP, Edwards, JR, Park, BJ, Fridkin, SK, Magill, SS. Incidence trends in pathogen-specific central line-associated bloodstream infections in US intensive care units, 1990-2010. Infect Control Hosp Epidemiol 2013;34:893899.
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Supplementary materials

O’Neil supplementary material
Non-ICU CLABSI Supplement Table

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