CLABSI infections in patients Discussion

Population (P) – Patients with central line associated bloodstream infections.

Intervention (I) – Use of CLABSI bundle protocol

Comparison (C) – No protocol

Outcome (O) – Decreased rates of CLABSI infections in patients

Time (T)- During hospital stay

LITERATURE SEARCH

Patel, P. A., Boehm, S., Zhou, Y., Zhu, C., Peterson, K. E., Grayes, A., & Peterson, L. R. (2017). Major Article: Prospective observational study on central line–associated bloodstream infections and central venous catheter occlusions using a negative displacement connector with an alcohol disinfecting cap. AJIC: American Journal Of Infection Control, 45115-120. doi:10.1016/j.ajic.2016.06.013

Abstract

Major complications in use of central venous catheter include bloodstream infection and occlusion. The article performed a prospective, observational study in determining the rate of central line–associated bloodstream infection as well as CVC occlusion using a negative displacement connector with an alcohol disinfecting cap. Patients were followed from the time of CVC insertion through 2 days after removal, at the time of hospital discharge if there was no documentation of removal. CLABSI was defined using National Healthcare Safety Network criteria. Data for evidence of lumen occlusions were extracted from the electronic health record. Direct observations were performed to assess adherence to hospital policy regarding CVC insertion practice. CLABSI infections in patients Discussion

Kramer, R. D., Conte, M., Mann, J., Saint, S., Chopra, V. (2017). Are antimicrobial peripherally inserted central catheters associated with reduction in central line–associated bloodstream infection? A systematic review and meta-analysis.American Journal of Infection Control, 45, 108-114. https://doi.org/10.1016/j.ajic.2016.07.021

Abstract

Antimicrobial peripherally inserted central catheters (PICCs) may reduce the risk of central line-associated bloodstream infection (CLABSI). However, data regarding efficacy are limited. We aimed to evaluate whether antimicrobial PICCs are associated with CLABSI reduction.MEDLINE, EMBASE, CINHAL, and Web of Science were searched from inception to July 2016; conference proceedings were searched to identify additional studies. Study selection and data extraction were performed independently by 2 authors.Available evidence suggests that antimicrobial PICCs may reduce CLABSI, especially in high-risk subgroups. Randomized trials are needed to assess efficacy across patient populations.

Trotter, T. (2016). Development of an Evidence-Based Maintenance Bundle for Preventing Central Line Associated Blood Stream Infections (CLABSIs) to Standardize Processes and Reduce CLABSI Rates. Journal of the Association for Vascular Access, 21(4), 269. doi:10.1016/j.java.2016.10.088

Abstract

Since 2012, CLABSIs rates at our facility have remained above or at the national average with over half occurring seven days after insertion, suggesting that central venous line (CVL) maintenance practices may have contributed.Standardization of central line practices has been shown to enhance patient safety and improve outcomes by reducing CLABSIs. To reduce maintenance-related CLABSIs, we evaluated current maintenance CVL practices and supporting organizational guidelines to assess standardization.

Gonzales, M., Rocher, I., Fortin, É., Fontela, P., Kaouache, M., Tremblay, C., & … Quach, C. (2013). A survey of Preventive Measures Used and their Impact on Central Line-Associated Bloodstream Infections (CLABSI) in Intensive Care Units (SPINBACC). BMC Infectious Diseases, 13(1), 1-14. doi:10.1186/1471-2334-13-562

Abstract

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 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.

Kaur, G. (2015). An Interdisciplinary Approach to Reduce Intensive Care Unit (ICU) Central line Associated Bloodstream Infections (CLABSIs) using LEAN Six Sigma…42nd Annual Conference Abstracts, APIC 2015, Nashville, TN June 2015. American Journal Of Infection Control, 43S64. doi:10.1016/j.ajic.2015.04.157

Abstract

Adult ICUs were experiencing an increase in CLABSIs since the beginning of the 2013 despite adherence to various evidence-based strategies. The goal was to have no CLABSIs in 2013, and to sustain this improvement.An interdisciplinary team of ICU RNs, Infection Prevention, and Vascular Access representative used Lean Six Sigma methodology to evaluate current processes, and identify vulnerabilities. As a consequence of intense brainstorming, accountability was added to existing evidence-based measures. This included creating and reviewing an educational poster highlighting appropriate line maintenance “best practices” with staff, creating an Employee Accountability Dashboard for each ICU where employee-specific central line care audits were posted with a smiley face if compliant, or a sad face if non-compliant.

Benjamin, W., & Reba, U. (2016). Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting. SAGE Open, Vol 6, Iss 4 (2016), (4), doi:10.1177/2158244016677747

Abstract

CLABSIs are common source of healthcare-associated infection. CLABSIincidence has been significantly reduced through the efforts of nurses and healthcare providers. Extrinsic factors such as recently enacted legislation and mandatory reporting have not been closely examined in relation to changes in rates of healthcare-associated infection. The article examined evidence-based practices related to CLABSI. There is disconnect in the methods and guidelines for reporting CLABSI between these programs, specifically among local monitoring agencies and the various federal oversight organizations. Future research will focus on addressing the gap in what defines a CLABSI and whether or not these programs to incentivize hospital to reduce CLABSI rates are effective. CLABSI infections in patients Discussion

References

Benjamin, W., & Reba, U. (2016). Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting. SAGE Open, Vol 6, Iss4 (2016), (4).

Gonzales, M., Rocher, I., Fortin, É., Fontela, P., Kaouache, M., Tremblay, C., & … Quach, C. (2013). A survey of Preventive Measures Used and their Impact on Central Line Associated Bloodstream Infections (CLABSI) in Intensive Care Units (SPINBACC). BMC Infectious Diseases, 13(1), 1-14.

Kramer, R. D., Conte, M., Mann, J., Saint, S., Chopra, V. (2017). Are antimicrobial peripherally inserted central catheters associated with reduction in central line–associated bloodstream infection? A systematic review and meta-analysis. American Journal of Infection Control, 45, 108-114.