A multicenter quasi-experimental study: impact of a central line infection control program using auditing and performance feedback in five Belgian intensive care units

Antimicrobial Resistance and Infection Control

Baudouin Byl¹  Sylvie Arias³  Michele Gerard²  Soraya Cherifi³ 

[1]School of Public Health, Université Libre de Bruxelles, Brussels, Belgium

[2]Infection Control Unit, Saint Pierre University Hospital, 322 Rue Haute, 1000 Brussels, Belgium

[3]Infection Control Unit, Brugmann University Hospital, 4 Place Van Gehuchten, 1020 Brussels, Belgium

关键词: Central-line associated bloodstream infection;    Intensive care unit;    Feedback;    Audit;   

Others  :  790683
DOI  :  10.1186/2047-2994-2-33

 received in 2013-09-27, accepted in 2013-12-02,  发布年份 2013

【 摘 要 】

Background

We analyzed the impact associated with an intervention based on process control and performance feedback to decrease central line-associated bloodstream infection (CLABSI) rates.

This study was conducted from March 2011 to September 2012 in five adult intensive care units (ICU) located in two Belgian tertiary hospitals A and B, with a total of 53 beds.

Methods

This study was divided in three phases: P1 (baseline), P2 (intervention) and P3 (post intervention).

During P2, external monitoring of five central venous catheters (CVC) care critical processes and monthly reporting (meetings and feedbacks reports posted) of performance indicators (CLABSI rate, CVC utilization ratio, compliance rate with each care process, and insertion site) to ICU workers were performed. The external monitoring of process measures was assessed by the same trained research nurse.

A Poisson regression analysis was used to compare CLABSI incidence density rate per phase. Statistical significance was achieved with 2-sided p-value of <0.05. For the analysis, we separated the five ICU in hospital A and B when appropriate.

Results

Significantly improved total mean compliance was achieved for hand hygiene, CVC handling and CVC dressing. CLABSI rate declined from 4.00 (95% confidence interval (CI): 1.94-6.06) to 1.81 (0.46-3.17) per 1,000 CVC-days in P2 with an incidence rate ratio (IRR) of 0.49 (0.24-0.98, p = 0.043). A better response was observed in hospital A where the nurse participation at the monthly meeting was significantly higher than in hospital B (p < 0.001) as the percentage of feedbacks reports posted in ICU (p < 0.001). The decline in the CLABSI rate observed during P2 in comparison with P1 was independent of the insertion site (femoral or non-femoral; p = 0.054). The overall CLABSI rate increased to 2.73 (1.17-4.29) per 1,000 CVC-days with IRR of 0.67 (0.36-1.26, p = 0.212) in P3 compared to P1, but a high nursing turnover was observed in both hospitals.

Conclusions

Our intervention focused on external auditing and performance feedback resulted in significant reduction in rates of CLABSI. Investigation continues regarding the most effective way to sustain CLABSI prevention practices and to improve the culture of safety in healthcare.

【 授权许可】

   
2013 Cherifi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]World Health Organization: Preventing bloodstream infections from central line venous catheters. 2012. http://www.who.int/patientsafety/implementation/bsi/en/index.html webcite
• [2]Tacconelli E, Smith G, Hieke K, Lafuma A, Bastide P: Epidemiology, medical outcomes and costs of catheter-related bloodstream infections in intensive care units of four European countries: literature- and registry-based estimates. J Hosp Infect 2009, 72:97-103.
• [3]Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM: Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004, 32:2014-2020.
• [4]Warren DK, Zack JE, Mayfield JL, Chen A, Prentice D, Fraser VJ, Kollef MH: The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU. Chest 2004, 126:1612-1618.
• [5]Coopersmith CM, Rebmann TL, Zack JE, Ward MR, Corcoran RM, Schallom ME, Sona CS, Buchman TG, Boyle WA, Polish LB, Fraser VJ: Effect on an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit. Crit Care Med 2002, 30:59-64.
• [6]Sherertz RJ, Ely EW, Westbrook DM, Gledhill KS, Streed SA, Kiger B, Flynn L, Hayes S, Strong S, Cruz J, Bowton DL, Hulgan T, Haponik EF: Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med 2000, 132:641-648.
• [7]Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D: Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000, 355:1864-1868.
• [8]Marra AR, Cal RG, Durão MS, Correa L, Guastelli LR, Moura DF Jr, Edmond MB, Dos Santos OF: Impact of a program to prevent central line-associated bloodstream infection in the zero tolerance era. Am J Infect Control 2010, 38:434-439.
• [9]Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006, 355:2725-2732.
• [10]Guerin K, Wagner J, Rains K, Bessesen M: Reduction in central line-associated bloodstream infections by implementation of a post-insertion care bundle. Am J Infect Control 2010, 38:430-433.
• [11]Longmate AG, Ellis KS, Boyle L, Maher S, Cairns CJ, Lloyd SM, Lang C: Elimination of central-venous catheter related bloodstream infections from the intensive care unit. BMJ Qual Saf 2011, 20:174-180.
• [12]Rosenthal VD, Ramachandran B, Villamil-Gómez W, Armas-Ruiz A, Navoa-Ng JA, Matta-Cortés L, Pawar M, Nevzat-Yalcin A, Rodríguez-Ferrer M, Yıldızdaş RD, Menco A, Campuzano R, Villanueva VD, Rendon-Campo LF, Gupta A, Turhan O, Barahona-Guzmán N, Horoz OO, Arrieta P, Brito JM, Tolentino MC, Astudillo Y, Saini N, Gunay N, Sarmiento-Villa G, Gumus E, Lagares-Guzmán A, Dursun O: Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC). Infection 2012, 40:415-423.
• [13]Rinke ML, Chen AR, Bundy DG, Colantuoni E, Fratino L, Drucis KM, Panton SY, Kokoszka M, Budd AP, Milstone AM, Miller MR: Implementation of a central line maintenance care bundle in hospitalized pediatric oncology patients. Pediatrics 2012, 130:996-1004.
• [14]Gaynes R, Richards C, Edwards J, Emori TG, Horan T, Alonso-Echanove J, Fridkin S, Lawton R, Peavy G, Tolson J: Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001, 7:295-298.
• [15]Wall RJ, Ely EW, Elasy TA, Dittus RS, Foss J, Wilkerson KS, Speroff T: Using real time process measurements to reduce catheter-related bloodstream infections in the intensive care unit. Qual Saf Health Care 2005, 14:295-302.
• [16]Higuera F, Rosenthal VD, Duarte P, Ruiz J, Franco G, Safdar N: The effect of process control on the incidence of central venous catheter-associated bloodstream infections and mortality in intensive care units in Mexico. Crit Care Med 2005, 33:2022-2027.
• [17]Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Calfee DP, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Kaye KS, Klompas M, Lo E, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS: Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008, 29(Suppl 1):S22-S30.
• [18]National Nosocomial Infections Surveillance (NNIS) system report: data summary from October 1986-April 1998, issued June 1998. Am J Infect Control 1998, 26:522-533.
• [19]Apisarnthanarak A, Thongphubeth K, Yuekyen C, Warren DK, Fraser VJ: Effectiveness of a catheter-associated bloodstream infection bundle in a Thai tertiary care center: a 3-year study. Am J Infect Control 2010, 38:449-455.
• [20]Furuya EY, Dick A, Perencevich EN, Pogorzelska M, Goldmann D, Stone PW: Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 2011, 6:e15452.
• [21]Marik PE, Flemmer M, Harrison W: The risk of catheter-related bloodstream infection with femoral venous catheters as compared to sublclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med 2012, 40:2479-2485.
• [22]Paula AP, Oliveira PR, Miranda EP, Felix CS, Lorigados CB, Giovani AM, Lima AL: The long-term impact of a program to prevent central line-associated bloodstream infections in a surgical intensive care unit. Clinics 2012, 67:969-970.
• [23]Robert J, Fridkin SK, Blumberg HM, Anderson B, White N, Ray SM, Chan J, Jarvis WR: The influence of the composition of nursing staff on primary bloodstream infection rates in a surgical intensive care unit. Infect Control Hosp Epidemiol 2000, 21:12-17.
• [24]Harris AD, Bradham DD, Baumgarten M, Zuckerman IH, Fink JC, Perencevich EN: The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis 2004, 38:1586-1591.