Bundle prevents CLABSIs in nursing homes
Key takeaways:
- The SAFER Lines bundle was created to aid prevention efforts for CLABSIs.
- The bundle reduced inflammation and infections at insertion sites and hospitalizations.
A prevention bundle reduce inflammation, infections and hospitalizations among nursing home residents with peripherally inserted central catheters, according to a study.
The Standard Assessment for Effective Response (SAFER) Lines bundle was created to help prevent central line-associated bloodstream infections (CLABSIs).
“The volume of patients requiring complex health care needs after leaving the hospital is increasing nationally. This is only expected to grow as the overall number of elderly people increases,” Shruti K. Gohil, MD, MPH, assistant professor of infectious diseases and associate medical director of epidemiology and infection prevention at the University of California, Irvine, told Healio.
“Patients who require long-term intravenous medications often leave the hospital with central venous catheters. Without proper preventive infection care, patients can develop CLABSIs, which are associated with extensive morbidity, mortality, and substantial excess health care costs,” she said.
Gohil explained that although hospitals have “robust CLABSI prevention processes,” strategies to prevent these infections after patients leave the hospital with these devices are “underdeveloped.” This led Gohil and colleagues to evaluate the impact of a new CLABSI prevention bundle in nursing homes called SAFER Lines.
According to the study, the SAFER Lines bundle was a CLABSI prevention program consisting of a central line insertion site assessment score that quantified insertion-site inflammation and standardized erythema by catheter width (3 mm) as a reference, paired with a mobile app that allowed daily central line photo assessments by nurses for early detection of high-risk lines, score-based automated alerts to physicians and automated physician alerting for remote response.
In total, 8,131 assessments of 817 peripherally inserted central catheters (PICCs) in 719 residents were included with the baseline group, including 4,865 assessments and 422 PICCs and the intervention group including 4,264 assessments and 395 PICCS.
After comparing baseline to intervention, researchers found there was a 50% decrease in lines with peeling dressings and that the bundle was associated with 57% lower odds of peeling dressings (OR = 0.43; 95% CI, 0.28-0.64).
The study also showed that among lines with at least one assessment of a visible insertion site, the proportion with localized infection or inflammation decreased from 29.9% during baseline to 12% during the intervention, with the bundle being associated with 73% lower odds of local inflammation/infection (OR = 0.27; 95% CI, 0.13-0.56)
The proportion of nursing home residents who were discharged to a hospital due to an infection also decreased after the bundle was introduced — from 42.9% to 31.1%. The researchers explained that the bundle was associated with a 41% lower risk of infection-related hospitalizations (OR = 0.59; 95% CI, 0.42-0.83).
According to the study, these results all remained significant on sensitivity analyses.
Gohil concluded, “Mobile app strategies can effectively improve CLABSI prevention practices, reduce locally inflamed/infected central lines, and reduce hospitalizations.”
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