A survey of Preventive Measures Used and their Impact on Central Line-Associated Bloodstream Infections (CLABSI) in Intensive Care Units (SPIN-BACC)

BMC Infectious Diseases

Caroline Quach²  Charles Frenette²  Claude Tremblay⁴  Mohammed Kaouache⁵  Patricia Fontela³  Élise Fortin³  Isabelle Rocher¹  Milagros Gonzales⁵ 

[1]Institut National de Santé Publique du Québec, Québec and Montréal, Montréal, Québec, Canada

[2]Department of Medical Microbiology and Infectious Diseases, McGill University Health Center, McGill University, Montreal, Québec, Canada

[3]Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada

[4]Centre Hospitalier Universitaire de Québec - Pavillon Hôtel-Dieu de Québec, Québec, Québec, Canada

[5]Department of Pediatrics, The Montreal Children’s Hospital, McGill University, Quebec, Québec, Canada

关键词: Compliance;    Bundles;    Preventive measures;    Intensive care units;    Central line associated bloodstream infections;   

Others  :  1138274
DOI  :  10.1186/1471-2334-13-562

 received in 2013-08-21, accepted in 2013-11-26,  发布年份 2013

【 摘 要 】

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-BACC – n = 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.

【 授权许可】

   
2013 Gonzales et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Fontela PS, Platt RW, Rocher I, Frenette C, Moore D, Fortin E, et al.: Surveillance Provinciale des Infections Nosocomiales (SPIN) Program: implementation of a mandatory surveillance program for central line-associated bloodstream infections. Am J Infect Control 2011, 39:329-335.
• [2]Fortin E, Quach C, Ngenda-Muadi M, Trudeau M, Frenette C: Surveillance provinciale des bactériémies nosocomiales sur cathéters centraux aux soins intensifs: Avril 2011 - Mars 2012. Canada: Institut national de santé publique du Québec, Direction des risques biologiques; 2012:48.
• [3]Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al.: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006, 355:2725-2732.
• [4]Kim JS, Holtom P, Vigen C: Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: epidemiologic and economic consequences. Am J Infect Control 2011, 39:640-646.
• [5]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.
• [6]Guerin K, Wagner J, Rains K, Bessesen M: Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle. Am J Infect Control 2010, 38:430-433.
• [7]McLaws ML, Burrell AR: Zero risk for central line-associated bloodstream infection: are we there yet? Crit Care Med 2012, 40:388-393.
• [8]Shuman EK, Washer LL, Arndt JL, Zalewski CA, Hyzy RC, Napolitano LM, et al.: Analysis of central line-associated bloodstream infections in the intensive care unit after implementation of central line bundles. Infect Control Hosp Epidemiol 2010, 31:551-553.
• [9]Fortin E, Rocher I, Frenette C, Tremblay C, Quach C: Healthcare-associated bloodstream infections secondary to a urinary focus: the Quebec provincial surveillance results. Infect Control Hosp Epidemiol 2012, 33:456-462.
• [10]Horan TC, Andrus M, Dudeck MA: CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008, 36:309-332.
• [11]O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al.: Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011, 52:e162-e193.
• [12]Bernier P, Boiteau P, Cass M, Couves L, Esmail R, Harries B, et al.: Prevent Central Line Infections, Central Line Associated - Blood Stream Infections (CLA-BSI); How-to Guide. In Safer Healthcare Now! Campaign. Edited by Canadian Patient Safety Institute. Canada: Canadian Patient Safety Institute; 2009.
• [13]Hu KK, Lipsky BA, Veenstra DL, Saint S: Using maximal sterile barriers to prevent central venous catheter-related infection: a systematic evidence-based review. Am J Infect Control 2004, 32:142-146.
• [14]Ilan R, Doan J, Cload B, Squires M, Day A: Removing nonessential central venous catheters: evaluation of a quality improvement intervention. Can J Anaesth 2012, 59:1102-1110.
• [15]Gillies D, Wallen Margaret M, Morrison Anne L, Rankin K, Nagy Sue A, O’Riordan E: Optimal timing for intravenous administration set replacement. Cochrane Database of Systematic Reviews. UK: John Wiley & Sons, Ltd; 2005.
• [16]Rupp ME, Yu S, Huerta T, Cavalieri RJ, Alter R, Fey PD, et al.: Adequate disinfection of a split-septum needleless intravascular connector with a 5-second alcohol scrub. Infect Control Hosp Epidemiol 2012, 33:661-665.
• [17]Maragakis LL, Bradley KL, Song X, Beers C, Miller MR, Cosgrove SE, et al.: Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port. Infect Control Hosp Epidemiol 2006, 27:67-70.
• [18]Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, Anderson DJ, et al.: Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008, 29(Suppl 1):S22-S30.
• [19]Jarvis WR, Murphy C, Hall KK, Fogle PJ, Karchmer TB, Harrington G, et al.: Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors. Clin Infect Dis 2009, 49:1821-1827.