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The association between implementation of second-tier prevention practices and CLABSI incidence: A national survey

Published online by Cambridge University Press:  24 July 2019

Debby Ben-David*
National Center for Infection Control, Israel Ministry of Health, Israel
Azza Vaturi
National Center for Infection Control, Israel Ministry of Health, Israel
Ester Solter
National Center for Infection Control, Israel Ministry of Health, Israel
Elizabeth Temkin
National Center for Infection Control, Israel Ministry of Health, Israel
Yehuda Carmeli
National Center for Infection Control, Israel Ministry of Health, Israel Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
Mitchell J. Schwaber
National Center for Infection Control, Israel Ministry of Health, Israel Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
the Israel CLABSI Prevention Working Group
National Center for Infection Control, Israel Ministry of Health, Israel Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
Author for correspondence: Debby Ben-David, MD, National Center for Infection Control, 6 Weizmann St, Tel Aviv 6423906 Israel. E-mail:



Prevention of central-line–associated bloodstream infection (CLABSI) represents a complex challenge for the teams involved in device insertion and maintenance. First-tier practices for CLABSI prevention are well established.


We describe second-tier prevention practices in Israeli medical-surgical ICUs and assess their association with CLABSI rates.


In June 2017, an online survey assessing infection prevention practices in general ICUs was sent to all Israeli acute-care hospitals. The survey comprised 14 prevention measures supplementary to the established measures that are standard of care for CLABSI prevention. These measures fall into 2 domains: technology and implementation. The association between the number of prevention measures and CLABSI rate during the first 6 months of 2017 was assessed using Spearman’s correlation. We used negative binomial regression to calculate the incidence rate ratio (IRR) associated with the overall number of prevention measures and with each measure individually.


The CLABSI rates in 24 general ICUs varied between 0.0 and 17.0 per 1,000 central-line days. Greater use of preventive measures was associated with lower CLABSI rates (ρ, –0.70; P < .001). For each additional measure, the incidence of CLABSI decreased by 19% (IRR, 0.81; 95% CI, 0.73–0.89). Specific measures associated with lower rates were involvement of ward champions (IRR, 0.47; 95% CI, 0.31–0.71), auditing of insertions by infection control staff (IRR, 0.35; 95% CI, 0.19–0.64), and simulation-based training (IRR, 0.38; 95% CI, 0.22–0.64).


Implementation of second-tier preventive practices was protective against CLABSI. Use of more practices was correlated with lower rates.

Original Article
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Members of the Israel CLABSI Prevention Working Group: Alexander Axel RN, MHA (Assuta Medical Centers, Tel Aviv); Shlomo L. Maayan MD, Daniel Jacobson MD, Yael Vilozni RN, MPHA and Vadim Berezovsky MD (Barzilai Medical Center, Ashkelon); Bina Rubinovitch MD and Hefziba Madar RN, MA (Beilinson Hospital, Rabin Medical Center, Petah Tikva); Alona Paz MD (Bnai Zion Medical Center, Haifa); Gabriel Weber MD, Shlomit Izhaki, MA, RN, Shereen Soboh RN, Mira Shitrit RN and Arieh Eden MD (Carmel Medical Center, Haifa); Bibiana Chazan MD, Iris Grinberg Avraham MSc, RN and Aied Abusebeih BSc, RN (Emek Medical Center, Afula); Yael Ziv MD, Alexander Samokhvalov MD, Emil Agha MPH and Elah Talker Rafter MPH (Galilee Medical Center, Nahariya); Tamar Gottesman Yekutieli MD and Rina Fedorowsky, RN, MA (Hasharon Hospital, Rabin Medical Center, Petah Tikva); Shmuel Benenson MD, MSc, Carmela Schwartz RN, MPH and Kami Harpaz RN, MPH (Hadassah-Hebrew University Medical Center, Ein Kerem and Mount Scopus campuses, Jerusalem); Carmela Gweta-Lugassy RN, BSN, MA (Herzliya Medical Center, Herzliya); Aliza Vaknin BA, Michal Stein MD and Orna Ben-Natan PhD (Hillel Yaffe Medical Center, Hadera); Lina Nasrawi RN, MPH (Holy Family Hospital, Nazareth); Pnina Ciobotaro MD, Maly Oved RN, MPA, Elena Kishinevsky MD, Yael Polishuk RN, MPA and Rita Bardenstein MSc (Kaplan Medical Center, Rehovot); Bat-Sheva Kloyzner BA (Mayanei Hayeshua Medical Center, Bnei Brak); Pnina Shitrit MD, Beatriz Gerber RN, Hani Laderman Schumer RN, Ortal Hilel RN and Ofra Benisty RN (Meir Medical Center, Kfar Saba); Hiba Zayyad MD and Kozita Labay MHA, RN (Baruch-Padeh Medical Center, Poriya); Khetam Hussein MD, Halima Dabaja-Younis MD, Orna Eluk RN and Tamar Alon RN (Rambam Medical Center, Haifa); Regev Cohen MD, Shoshana Cohen RN, BA and Marina Afraimov RN, MA (Sanz Medical Center, Laniado Hospital, Netanya); Ronit Nativ MPH, RN and Seada Eskira MPH, RN (Soroka Medical Center, Beer Sheva); Yonit Wiener-Well MD and Liora Bier RN, MA (Shaare Zedek Medical Center, Jerusalem); Dror Marchaim MD, Lili Goldshtein RN, MPH and Dan Klafter RN, BSN, MPH, EMT-P (Shamir Medical Center, Assaf Harofeh campus, Zerifin); Ilana Tal RN, MA and Elena Machtin RN, BA (Sheba Medical Center, Ramat Gan); Meirav Mor MD2, Sigalit Rozenfeld RN, Ester Shmuelov RN and Elhanan Nahum MD2(Schneider Children’s Medical Center of Israel, Petah Tikva); Vered Schechner MD, MSc and Anna Perechododnik RN (Tel Aviv Medical Center, Tel Aviv); Yasmin Maor MD2 and Orly Agmon MN (Wolfson Medical Center, Holon); *Jalal Tarabeia PhD (Faculty of Nursing, The Max Stern Yezreel Valley College; Ziv Medical Center, Zefat) and Miriam Sudri BA (Ziv Medical Center, Zefat).


The affiliation for Jalal Tarabeia in the working group has been corrected. A corrigendum notice detailing this change was also published (DOI: 10.1017/ice.2019.272).


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