Complete Audit Cycle: CLABSI Bundle Compliance in ICU

Antimicrobial Resistance & Infection Control, 2016

Background: Central line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable. We documented attitudes and practices in intensive care units (ICUs) in 2015 in order to assess compliance with CLABSI prevention guidelines. Methods: Between June and October 2015, an online questionnaire was made available to medical doctors and nurses working in ICUs worldwide. We investigated practices related to central line (CL) insertion, maintenance and measurement of CLABSI-related data following the SHEA guidelines as a standard. We computed weighted estimates for high, middle and low-income countries using country population as a weight. Only countries providing at least 10 complete responses were included in these estimates. Results: Ninety five countries provided 3407 individual responses; no low income, 14 middle income (MIC) and 27 high income (HIC) countries provided 10 or more responses. Of the total respondents, 80% (MIC, SE = 1.5) and 81% (HIC, SE = 1.0) reported availability of written clinical guidelines for CLABSI prevention in their ICU; 23% (MIC,SE = 1.7) and 62% (HIC,SE = 1.4) reported compliance to the following (combined) recommendations for CL insertion: hand hygiene, full barrier precaution, chlorhexidine >0.5%, no topic or systemic antimicrobial prophylaxis; 60% (MIC,SE = 2.0) and 73% (HIC,SE = 1.2) reported daily assessment for the need of a central line. Most considered CLABSI measurement key to quality improvement, however few were able to report their CLABSI rate. Heterogeneity between countries was high and country specific results are made available. Conclusions: This study has identified areas for improvement in CLABSI prevention practices linked to CL insertion and maintenance. Priorities for intervention differ between countries.

BMC Infectious Diseases, 2013

Background: The Quebec central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs) Surveillance Program saw a decrease in CLABSI rates in most ICUs. Given the surveillance trends observed in recent years, we aimed to determine what preventive measures have been implemented, if compliance to measures was monitored and its impact on CLABSI incidence rates. Methods: All hospitals participating in the Quebec healthcare-associated infections surveillance program (SPIN-BACCn = 48) received a 77-question survey about preventive measures implemented and monitored in their ICU. The questionnaire was validated for construct, content, face validity, and reliability. We used Poisson regression to measure the association between compliance monitoring to preventive measures and CLABSI rates. Results: Forty-two (88%) eligible hospitals completed the survey. Two components from the maximum barrier precautions were used less optimally: cap (88%) and full sterile body drape (71%). Preventive measures reported included daily review of catheter need (79%) and evaluation of insertion site for the presence of inflammation (90%). Two hospitals rewired lines even if an infection was suspected or documented. In adult ICUs, there was a statistically significant greater decrease in CLABSI rates in ICUs that monitored compliance to preventive insertion measures, after adjusting for teaching status and the number of hospital beds (p = 0.036). Conclusions: Hospitals participating to the SPIN-BACC program follow recommendations for CLABSI prevention, but only a minority locally monitor their application. Compliance monitoring of preventive measures for catheter insertion was associated with a decrease in CLABSI incidence rates.

Saudi Medical Journal, 2018

Objectives: To assess nurses' compliance with central line associated bloodstream infection)CLABSI(prevention guidelines related to maintenance of the central line and the predictors of compliance. Method: This was an observational study that used a descriptive cross-sectional design. A sample of 171 intensive care unit)ICU(nurses were observed and their compliance was recorded on a structured observational sheet. The study was conducted in the ICUs of 15 hospitals located in 5 cities in Jordan. Data were collected over a 5-month period from March to July 2017. Central lines were all inserted by physicians inside the ICUs. Results: One hundred and twenty participants)70%(showed sufficient compliance. The mean compliance scores were 14.2±4.7)min=8, max=20(; however, the rate of CLABSI was variable across the participating ICUs. Logistic regression with 4 independent variables)years of experience, previous education with CLABSI, nurse-patient ratio and the ICU's bed capacity(was conducted to investigate predictors of sufficient compliance. The model was significant (χ 2)4(=133.773, p=0.00(. The nurse-patient ratio was the only significant predictor. Nurses with a 1:1 nurse:patient ratio demonstrated superior compliance over their counterparts with a 1:2 ratio. Conclusion: Further improvement in compliance and patients' outcomes could be achieved by lowering the nurse-patient ratio.

American Journal of Infection Control, 2013

Background: "Zero" central line-associated bloodstream infections (CLABSI) have not been reported from Asian countries, which usually have predominance of difficult to curtail gram negative infections. It also remains unclear whether lowering CLABSI rates below National Healthcare Safety Network (NHSN) benchmarks in such countries is even possible. In this study, we evaluated effects of a quality improvement initiative to achieve "Zero CLABSI" in our intensive care unit. Methods: A root cause analysis in February 2010 identified problems with clinical practice, environment, and products. Extensive education sessions were followed by implementation of strategies in the form of "itemized" bundles derived from practice guidelines, with complete enforcement starting August 2010. Results were benchmarked against NHSN data. Data were analyzed in a preintervention (1 year) and postintervention (2 years) fashion, using Poisson regression analysis to generate incidence-rate ratio (IRR). Results: In the preintervention period, CLABSI rate was 6.9/1,000 catheter-days (CDs) (35 CLABSI/5,083 CDs). In the postintervention year 1, rate was 1.06/1,000 CDs (4 CLABSI/3,787 CDs) with IRR of 0.15 (95% confidence interval: 0.04-0.44, P < .001) and reduction of 85%. In postintervention year 2, rate was 0.35/ 1,000 CDs (1/2,860 CDs) with IRR of 0.05 (95% confidence interval: 0.001-0.31, P < .001). There was a period of "Zero CLABSI" for 15 consecutive months, surpassing NHSN benchmarks. Conclusion: : CLABSIs can be eliminated in any intensive care unit regardless of the location and type of organism. NHSN data should be a realistic CLABSI benchmarking target for developing countries.

Current Infectious Disease Reports, 2015

Central line-associated bloodstream infections (CLABSI) are one of the leading causes of death in the USA and around the world. As a preventable healthcare-associated infection, they are associated with significant morbidity and excess costs to the healthcare system. Effective and long-term CLABSI prevention requires a multifaceted approach, involving evidencebased best practices coupled with effective implementation strategies. Currently recommended practices are supported by evidence and are simple, such as appropriate hand hygiene, use of full barrier precautions, avoidance of femoral lines, skin antisepsis, and removal of unnecessary lines. The most successful and sustained improvements in CLABSI rates further utilize an adaptive component to align provider behaviors with consistent and reliable use of evidence-based practices. Great success has been achieved in reducing CLABSI rates in the USA and elsewhere over the past decade, but more is needed. This article aims to review the initiatives undertaken to reduce CLABSI and summarizes the sentinel and recent literature regarding CLABSI and its prevention.

2021

Problem description: Central line associated blood stream infection (CLABSI) is one of the deadliest types of hospital acquired infection and blood stream infection, raising patient mortality by 12-25% and accounting for 28,000 deaths annually in the United States. CLABSI also increases morbidity, length of stay, and costs hospitals an average of $48,000 per case. Effective measures for CLABSI prevention are needed for an adult intensive care unit (ICU) of an urban hospital to decrease the financial burden of CLABSI, improve quality of care, and prevent patient harm. Setting: The microsystem of focus is a 36-bed high acuity ICU. Patients of this ICU are on average 51 to 65 years of age with the top three diagnoses being heart failure, liver failure, and transplant of mostly heart and liver. Thirteen CLABSIs occurred at this hospital since its opening in 2019. Counterproductive patterns regarding central line care were targeted for change, mainly focusing on lack of compliance in nur...

Critical Care Medicine, 2012

N early 250,000 healthcareassociated infections occur annually in patients with central lines placed to deliver life-saving medical care (1). Furthermore, 25% of patients contracting a central line-associated bloodstream infection (CLABSI) in the intensive care unit (ICU) die, totaling 31,000 deaths annually in the United States (2). A recent review estimated an added annual cost of $9 billion to the U.S. healthcare system (3). Previous quality improvement studies suggest that these infections are largely preventable (4-8). However, these studies were based on nonrandomized trials with historical or contemporaneous controls. These designs might overestimate the effect of the intervention and may not be sufficient to establish a causal relationship between the interventions and the reduced infections (9, 10), especially when a consistent national decline in CLABSIs was found in all types of ICUs in the United States over the same period (11). The Keystone ICU collaborative in Michigan (12) used a bundle of evidence-based bloodstream infection prevention practices coupled with a program to improve patient safety, communication, and teamwork, known as the Comprehensive Unit-based Safety Program (CUSP) (13). Together these interventions reduced the overall CLABSI rate by 66% in a cohort of ICUs (7). Nevertheless, this cohort study, with no concurrent control group, was not able to establish a causal relationship between the intervention and the reduced CLABSI rate. The rational next scientific step was to test a causal relationship between this multifaceted intervention and reduced CLABSI rates in a randomized controlled trial (RCT) to evaluate the magnitude of the effectiveness of the intervention. This article reports our findings. METHODS Design and Setting. We used a multicenter, phased, cluster RCT to implement and test the multifaceted intervention designed to improve safety, safety climate, and the use of evidencebased practices to prevent bloodstream infections. Two faith-based, affiliated health systems with hospitals in the West (Adventist Health) and in the Midwest and Southeast regions (Adventist Health System) of the country were

PLoS ONE, 2011

Background: Central line-associated bloodstream infections (CLABSI) represent a serious patient safety issue. To prevent these infections, bundled interventions are increasingly recommended. We examine the extent of adoption of Central Line (CL) Bundle elements throughout US intensive care units (ICU) and determine their effectiveness in preventing CLABSIs.

THE THERAPIST (Journal of Therapies &amp; Rehabilitation Sciences)

CLABSIs are some of the utmost fatal hospital-acquired infections. CLABSIs cost up to $45,000 per infection around the world. CDC reported that in U.S. hospitals around 41,000 preventable CLABSIs occur every year, so the magnitude of the problem could be worse in Pakistan where there are still gaps in documenting the hospital data. Objective: To identify the nurses&#39; knowledge and compliance and their association regarding prevention of CLABSI in public and private sector hospitals of Peshawar. Methods: An analytical cross-sectional study was carried out among 140 Nurses working in Intensive Care Units of (LRH & RMI) who had at least one year of experience. Enumerative or census sampling method was used to take the entire eligible ICU nurses as a sample. Data was collected through a validated and pre pilot tested questionnaire and checklist. Results: Around 30% of the nurses had poor knowledge, 43.6% had an average knowledge, 22.1% good knowledge and only 3.6% had an excellent kn...

Annals of Clinical Microbiology and Antimicrobials, 2013

Background: Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey. Methods: We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1-bundle of infection control interventions, 2-education, 3-outcome surveillance, 4-process surveillance, 5-feedback of CLAB rates, and 6-performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention. Results: During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43-0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB.