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Central line infection prevention bundle reduces catheter use, CLABSI
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An infection prevention bundle effectively reduced dwell time, central venous catheter use and central line-associated bloodstream infection in a recent study.
“Prevention of [central line-associated bloodstream infection (CLABSI)] is a key objective for improvement of patient safety and reduction of mortality, hospital stay, and costs,” Rowena McMullan, FRACP, and Adrienne Gordon, PhD, both from the department of newborn care at Royal Prince Alfred Hospital Women and Babies, Sydney, Australia, wrote. “The aim of this study was to compare CLABSI rates before and after the introduction of the CLABSI prevention bundle to determine its effectiveness and to identify areas for further improvement.”
CLABSI can be modified through the use of health care intervention bundles, the researchers wrote. In their retrospective cohort study, McMullan and Gordon tested the effectiveness of a prevention bundle on CLABSI rates. The intervention bundle included the insertion of a central venous catheter (CVC), its maintenance, an education component, and surveillance and feedback on the program.
The researchers analyzed data from their hospital’s neonatal ICU for all of 2012 (baseline period) and from August 2013 through July 2014 (intervention period). The researchers specifically reviewed areas where CLABSI prevention failed. Based on information from the neonatal clinical database, the researchers determined which infants had a CVC placed during admission and details on any bloodstream infection. These data were reviewed and compared for both study periods.
In the intervention phase, the number of CVCs inserted was reduced, and the central line utilization rate was 0.16 compared with 0.2 at baseline (P < .0001). CVC dwell time also decreased from 7.3 days (95% CI, 4-10.4) during the baseline period to 6 days (95% CI, 5-11.8). Further, the incidence of CLABSI was reduced, declining from11.5 per 1,000 central-line days during baseline to 1.2 per 1,000 central-line days (P < .0001) for peripherally inserted CVCs during the intervention.
“The reductions in the number of CVCs inserted, CVC dwell time, and CLABSI rates provide further data in support of CLABSI prevention intervention bundles,” the researchers wrote. “The reduction of health care-associated infection is a nationally important issue, and we have demonstrated the substantial impact that can be made within a single unit with a bundle of interventions.” – by Rafi Naseer
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Judith A. Guzman-Cottrill, DO
We say in pediatrics, “It takes a village to raise a child,” and I always say in my line of work in the health care setting, ‘It takes a village to prevent an infection.” It cannot just be one component to prevent a health care-associated infection, but requires the buy-in and the active, continuous work and feedback of the entire health care team to prevent every infection in the health care setting.
No matter what the age, when any patient develops a CLABSI, it definitely will increase costs related to health care. Additionally, it will expose the patient to more antibiotics, which we are learning with more research that antibiotic exposure has implications at the patient level, in terms of affecting the microbiome of the patient’s intestine, as well as at the public health level, in terms of increasing antimicrobial resistance.
The most important take-home message from this study is that CLABSI prevention needs to be an ongoing process, not simply a one-time intervention. A crucial component of this study was that the educational sessions occurred every 3 months and were standardized, which ensured that all new hires received the same standardized education. I believe ongoing education of the best site staff, who really are the ones that can make a difference, is especially critical.
Another important aspect of infection prevention is not only consistent, continuing education, but also ensuring that the bedside nurses — rather than just the leadership of the unit — are aware of the data. That they are aware of the infection, not just the infection that they may have been involved with.
Our neonatal ICU performed a similar type of intervention a few years ago, as part of a statewide collaborative that included five or six NICUs in our state, and the one piece that I think the bedside staff felt like was the most important was that open, continuous dialogue of infection prevention, what we can do to prevent infection, and it really changed the “culture of the unit.” Nurses felt more open to voice concerns in weaknesses in the infection prevention plan, and it ended up reaching beyond central line infections, as we identified risks for other types of infections that could occur in the same unit.
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