Improved CLABSI prevention bundles
Abstract:
Background: The risk of central-line associated bloodstream infection (CLABSI) is associated with central venous catheter (CVC) dwelling time. We implemented a hospital-wide intervention aimed to alert physicians to CVC-duration and necessity and to improve the monitoring of CLABSI prevention process-measures outside the intensive care unit (ICU).
Methods: A retrospective, before-after study that evaluated short-term, non-hemodialysis CVCs in and out of the ICU. The intervention included enhanced bundle-prevention measures monitoring and staff ‘sensitization’ regarding prolonged (>7 days) CVCs (pCVCs). The ICU intervention also included daily CVC-stewardship visits. We assessed CVC-utilizations and CLABSI episodes 20 months before, to 19 months after the intervention using Mann-Whitney tests.
Results: Out of the ICU, CVC-utilization ratio (CVC-UR) and pCVC-UR reduced significantly (4.1 to 2.7/100 HD, p=0.005; and 28% to 21%, p=0.02, respectively). Bundle-prevention measures improved and CLABSI rates reduced post-intervention (7.9 to 3.6/1000 CVC days, p=0.03). In the ICU, pCVC-UR reduced significantly (29% to 15%, p<0.0001). Baseline ICU-CLABSI rates were low and did not reduce post-intervention.
Conclusions: Sensitizing physicians to the existence and duration of CVCs accompanied with improved bundle-prevention measures, resulted in reduction of pCVCs, and outside the ICU, also in reduction of CVC-UR and CLABSI rates.
Reference:
Regev C, Shelly LA, Lamis M, Linor I, Olga FS, Sharon R, Orna BN, Aliza V, Mohammed G, Razi AH, Erez K, Noa M, Sarit F, Maanit S, Nina A, Ayed D, Ronit R, Valery I, Rena A, Saif AM, Rotem N, Marinella B, Vlada D, Boris K, Veacheslav Z, Veronika S, Inna F, Konstantin N, Yaakov D, Mohanad G, Fanny B, Boris I, Elias T. Targeting prolonged short-term central venous catheters to reduce hospital-wide catheter days and CLABSI rates. Am J Infect Control. 2024 Oct 18:S0196-6553(24)00799-5. doi: 10.1016/j.ajic.2024.10.011. Epub ahead of print. PMID: 39427926.