Behavioral tactics for CLABSI prevention should be emphasized, survey shows
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Key takeaways:
- Technical interventions such as sterile barriers were frequently used to prevent central line-associated bloodstream infections.
- Improvement is needed in use of behavioral and socio-adaptive tactics.
A nationally representative survey showed high use of evidence-based technical interventions to prevent central line-associated bloodstream infections in recent years; however, gaps remain in use of behavioral interventions.
“This study was prompted by a desire to understand the incidence of technical, behavioral, and leadership practices recommended to prevent central line-associated bloodstream infections (CLABSI),” Larissa Pisney, MD, medical director of infection prevention and control at the University of Colorado Hospital and UCHealth Denver Metro, told Healio.
“Data from the National Healthcare Safety Network show a significantly higher incidence of not just CLABSIs but also catheter-associated urinary tract infections, ventilator-associated events, and methicillin-resistant Staphylococcus aureus bacteremia in 2021 compared to 2019,” she said.
Pisney noted that several pandemic-related factors, including higher patient acuity and staffing shortages, likely contributed to the situation.
“We wanted to understand better where prevention strategies should be focused post-pandemic,” she said.
To assess the use of technical and behavioral interventions for preventing CLABSI, Pisney and colleagues sent surveys to infection preventionists at 881 U.S. acute care hospitals. Survey questions assessed the use of technical interventions to prevent CLABSI, as well as behavioral and socio-adaptive interventions such as feedback of CLABSI rates and use of appropriateness criteria.
The researchers received 415 (47%) survey responses, which showed that technical interventions such as maximal sterile barriers and chlorhexidine gluconate-containing dressings were highly prevalent at surveyed facilities (99% and 92%, respectively). Other practices, such as chlorhexidine gluconate bathing, were less common, especially outside the ICU setting (68% in ICU settings vs. 18% in non-ICU settings).
Behavioral and socio-adaptive practices such as the use of systems to monitor CLABSI (97%) were widely used; however, feedback to providers on CLABSI events was reported by only 89%, while tools to determine the appropriateness of central venous catheters were reported by only 53%. Additionally, only 23% of respondents reported strategies to reduce routine blood cultures.
Based on these findings, Pisney said that there is a need for increased emphasis on behavioral and socio-adaptive tactics to prevent CLABSI while still maintaining evidence-based technical interventions.
“The ability to hard-wire tools into the electronic medical record rather than relying solely on education on best practices, such as daily prompts to remove CVCs when no longer indicated to reduce unnecessary line days, will be crucial to the success of CLABSI prevention measures,” she said. “In a post-pandemic era, as many hospitals work to address ongoing staffing challenges, it is critical that infection preventionists have strong partnerships with hospital leadership to ensure the needed resources are allocated to address these gaps.”
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