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Use of Implementation Science for a Sustained Reduction of Central-Line–Associated Bloodstream Infections in a High-Volume, Regional Burn Unit

Published online by Cambridge University Press:  13 September 2017

Geeta Sood ,
Julie Caffrey ,
Kelly Krout ,
Zeina Khouri-Stevens ,
Kevin Gerold ,
Stefan Riedel ,
Janet McIntyre ,
Lisa L. Maragakis ,
Renee Blanding  and
Jonathan Zenilman
...Show all authors
Geeta Sood*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
Julie Caffrey
Affiliation:
Department of Plastic Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland
Kelly Krout
Affiliation:
Johns Hopkins Bayview Medical Center, Baltimore, Maryland
Zeina Khouri-Stevens
Affiliation:
Johns Hopkins International, Johns Hopkins Aramco Hospital, Saudi Arabia
Kevin Gerold
Affiliation:
Department of Anesthesia and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
Stefan Riedel
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Janet McIntyre
Affiliation:
Johns Hopkins Bayview Medical Center, Baltimore, Maryland
Lisa L. Maragakis
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland Department of Infection Prevention, Johns Hopkins Medicine, Baltimore, Maryland
Renee Blanding
Affiliation:
Department of Anesthesia and Critical Care Medicine School of Medicine, Johns Hopkins University, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
Jonathan Zenilman
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland
Richard Bennett
Affiliation:
Department of Medicine, Johns Hopkins University, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
Peter Pronovost
Affiliation:
Anesthesiology and Critical Care Medicine, Johns Hopkins University, Johns Hopkins Medicine, Baltimore, Maryland
*
Address correspondence to Geeta Sood, MD, Division of Infectious Diseases, Mason F. Lord Building, Center Tower, 3rd Floor, Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Baltimore, MD, 21224 (gsood1@jhmi.edu).
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Abstract

OBJECTIVE

We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line–associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU).

DESIGN

A single center observational quasi-experimental study.

SETTING

A regional BICU in Maryland serving 300–400 burn patients annually.

INTERVENTIONS

In 2011, an organizational-level and unit-level intervention was implemented to reduce the rates of CLABSI in a high-risk patient population in the BICU. At the organization level, leaders declared a goal of zero infections, created an infrastructure to support improvement efforts by creating a coordinating team, and engaged bedside staff. Performance data were transparently shared. At the unit level, the Comprehensive Unit-based Safety Program (CUSP)/ Translating Research Into Practice (TRIP) model was used. A series of interventions were implemented: development of new blood culture procurement criteria, implementation of chlorhexidine bathing and chlorhexidine dressings, use of alcohol impregnated caps, routine performance of root-cause analysis with executive engagement, and routine central venous catheter changes.

RESULTS

The use of an implementation science framework to guide multiple interventions resulted in the reduction of CLABSI rates from 15.5 per 1,000 central-line days to zero with a sustained rate of zero CLABSIs over 3 years (rate difference, 15.5; 95% confidence interval, 8.54–22.48).

CONCLUSIONS

CLABSIs in high-risk units may be preventable with the a use a structured organizational and unit-level paradigm.

Infect Control Hosp Epidemiol 2017;38:1306–1311

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 11 , November 2017 , pp. 1306 - 1311
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle ScholarPubMed
2. Januel, JM, Harbarth, S, Allard, R, et al. Estimating attributable mortality due to nosocomial infections acquired in intensive care units. Infect Control Hosp Epidemiol 2010;31:388–394.CrossRefGoogle ScholarPubMed
3. Pronovost, PJ, Cleeman, JI, Wright, D, Srinivasan, A. Fifteen years after To Err is Human: a success story to learn from. BMJ Qual Saf 2016;25:396–399.CrossRefGoogle Scholar
4. Dudeck, MA, Edwards, JR, Allen-Bridson, K, et al. National Healthcare Safety Network report, data summary for 2013, Device-associated module. Am J Infect Control 2015;43:206–221.CrossRefGoogle ScholarPubMed
5. O’Sullivan, ST, O’Connor, TP. Immunosuppression following thermal injury: the pathogenesis of immunodysfunction. Br J Plast Surg 1997;50:615–623.CrossRefGoogle ScholarPubMed
6. Brusselaers, N, Monstrey, S, Snoeij, T, et al. Morbidity and mortality of bloodstream infections in patients with severe burn injury. Am J Crit Care 2010;19:e81–e87.CrossRefGoogle ScholarPubMed
7. Shupp, JW, Pavlovich, AR, Jeng, JC, et al. Epidemiology of bloodstream infections in burn-injured patients: a review of the national burn repository. J Burn Care Res 2010;31:521–528.CrossRefGoogle ScholarPubMed
8. Bang, RL, Gang, RK, Sanyal, SC, Mokaddas, E, Ebrahim, MK. Burn septicaemia: an analysis of 79 patients. Burns 1998;24:354–361.CrossRefGoogle ScholarPubMed
9. Lee, HG, Jang, J, Choi, JE, et al. Blood stream infections in patients in the burn intensive care unit. Infect Chemother 2013;45:194–201.CrossRefGoogle ScholarPubMed
10. Lesseva, M. Central venous catheter-related bacteraemia in burn patients. Scand J Infect Dis 1998;30:585–589.CrossRefGoogle ScholarPubMed
11. Raz-Pasteur, A, Hussein, K, Finkelstein, R, Ullmann, Y, Egozi, D. Blood stream infections (BSI) in severe burn patients—early and late BSI: a 9-year study. Burns 2013;39:636–642.CrossRefGoogle Scholar
12. Santucci, SG, Gobara, S, Santos, CR, Fontana, C, Levin, AS. Infections in a burn intensive care unit: experience of seven years. J Hosp Infect 2003;53:6–13.CrossRefGoogle Scholar
13. Mason, AD, McManus, AT, Pruitt, BA. Association of burn mortality and bacteremia. A 25-year review. Arch Surg 1986;121:1027–1031.CrossRefGoogle ScholarPubMed
14. Appelgren, P, Björnhagen, V, Bragderyd, K, Jonsson, CE, Ransjö, U. A prospective study of infections in burn patients. Burns 2002;28:39–46.CrossRefGoogle ScholarPubMed
15. Patel, BM, Paratz, JD, Mallet, A, et al. Characteristics of bloodstream infections in burn patients: an 11-year retrospective study. Burns 2012;38:685–690.CrossRefGoogle ScholarPubMed
16. Wurtz, R, Karajovic, M, Dacumos, E, Jovanovic, B, Hanumadass, M. Nosocomial infections in a burn intensive care unit. Burns 1995;21:181–184.CrossRefGoogle Scholar
17. Sood, G, Heath, D, Adams, K, et al. Survey of central line-associated bloodstream infection prevention practices across american burn association-certified adult burn units. Infect Control Hosp Epidemiol 2013;34:439–440.CrossRefGoogle ScholarPubMed
18. Pronovost, PJ, Weaver, SJ, Berenholtz, SM, et al. Reducing preventable harm: observations on minimizing bloodstream infections. J Health Organ Manag 2017;31:2–9.CrossRefGoogle ScholarPubMed
19. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.CrossRefGoogle ScholarPubMed
20. Pronovost, PJ, Berenholtz, SM, Needham, DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ 2008;337:a1714.CrossRefGoogle Scholar
21. Greenhalgh, DG, Saffle, JR, Holmes, JHt, et al. American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res 2007;28:776–790.CrossRefGoogle ScholarPubMed
22. Hogan, BK, Wolf, SE, Hospenthal, DR, et al. Correlation of American Burn Association sepsis criteria with the presence of bacteremia in burned patients admitted to the intensive care unit. J Burn Care Res 2012;33:371–378.CrossRefGoogle ScholarPubMed
23. Murray, CK, Hoffmaster, RM, Schmit, DR, et al. Evaluation of white blood cell count, neutrophil percentage, and elevated temperature as predictors of bloodstream infection in burn patients. Arch Surg 2007;142:639–642.CrossRefGoogle ScholarPubMed
24. Vindenes, H, Bjerknes, R. The frequency of bacteremia and fungemia following wound cleaning and excision in patients with large burns. J Trauma 1993;35:742–749.CrossRefGoogle ScholarPubMed
25. Beard, CH, Ribeiro, CD, Jones, DM. The bacteraemia associated with burns surgery. Br J Surg 1975;62:638–641.CrossRefGoogle ScholarPubMed
26. Petersen, SR, Umphred, E, Warden, GD. The incidence of bacteremia following burn wound excision. J Trauma 1982;22:274–279.CrossRefGoogle ScholarPubMed
27. Mamattah, HJ, Beard, CH, Jones, DM. Bacteremia in the burned patient. J Clin Pathol 1973;26:388–389.CrossRefGoogle ScholarPubMed
28. Keen, A, Knoblock, L, Edelman, L, Saffle, J. Effective limitation of blood culture use in the burn unit. J Burn Care Rehabil 2002;23:183–189.CrossRefGoogle ScholarPubMed
29. Wright, MO, Tropp, J, Schora, DM, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control 2013;41:33–38.CrossRefGoogle ScholarPubMed
30. Oto, J, Imanaka, H, Konno, M, Nakataki, E, Nishimura, M. A prospective clinical trial on prevention of catheter contamination using the hub protection cap for needleless injection device. Am J Infect Control 2011;39:309–313.CrossRefGoogle ScholarPubMed
31. Timsit, JF, Mimoz, O, Mourvillier, B, et al. Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med 2012;186:1272–1278.CrossRefGoogle ScholarPubMed
32. Eyer, S, Brummitt, C, Crossley, K, Siegel, R, Cerra, F. Catheter-related sepsis: prospective, randomized study of three methods of long-term catheter maintenance. Crit Care Med 1990;18:1073–1079.CrossRefGoogle ScholarPubMed
33. Cobb, DK, High, KP, Sawyer, RG, et al. A controlled trial of scheduled replacement of central venous and pulmonary-artery catheters. N Engl J Med 1992;327:1062–1068.CrossRefGoogle ScholarPubMed
34. Cook, D, Randolph, A, Kernerman, P, et al. Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med 1997;25:1417–1424.CrossRefGoogle ScholarPubMed
35. Sheridan, RL, Neely, AN, Castillo, MA, et al. A survey of invasive catheter practices in US burn centers. J Burn Care Res 2012;33:741–746.CrossRefGoogle ScholarPubMed
36. Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159–1171.CrossRefGoogle ScholarPubMed
37. Popp, JA, Layon, AJ, Nappo, R, Richards, WT, Mozingo, DW. Hospital-acquired infections and thermally injured patients: chlorhexidine gluconate baths work. Am J Infect Control 2014;42:129–132.CrossRefGoogle ScholarPubMed
38. van Duin, D, Jones, SW, Dibiase, L, et al. Reduction in central line-associated bloodstream infections in patients with burns. Infect Control Hosp Epidemiol 2014;35:1066–1068.CrossRefGoogle ScholarPubMed
39. Marshall, M, Pronovost, P, Dixon-Woods, M. Promotion of improvement as a science. Lancet 2013;381:419–421.CrossRefGoogle ScholarPubMed
40. Pronovost, PJ, Sutcliffe, KM, Basu, L, Dixon-Woods, M. Change the story, change the results. Bull WHO 2017;95:478–480.Google Scholar