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Practices to prevent central line-associated bloodstream infection: A 2021 survey of infection preventionists in US hospitals

Published online by Cambridge University Press:  24 April 2024

Larissa Pisney ,
Lisa Camplese ,
M. Todd Greene Open the ORCID record for M. Todd Greene [Opens in a new window] ,
Sanjay Saint ,
Karen E. Fowler Open the ORCID record for Karen E. Fowler [Opens in a new window]  and
Vineet Chopra Open the ORCID record for Vineet Chopra [Opens in a new window]
Larissa Pisney
Affiliation:
The Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA University of Colorado Health System, Aurora, CO, USA
Lisa Camplese
Affiliation:
University of Colorado Health System, Aurora, CO, USA
M. Todd Greene
Affiliation:
VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
Sanjay Saint
Affiliation:
VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
Karen E. Fowler
Affiliation:
VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
Vineet Chopra*
Affiliation:
Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz, Aurora, CO, USA
*
Corresponding author: Vineet Chopra; Email: vineet.chopra@cuanschutz.edu
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Abstract

Objective:

To determine prevalence of technical and behavioral interventions aimed at preventing central line-associated bloodstream infection (CLABSI) following the COVID19 pandemic.

Design:

Cross-sectional survey.

Setting:

US acute care hospitals.

Participants:

Infection preventionists at participating hospitals.

Methods:

Surveys were sent to infection preventionists from a national random sample of 881 US acute care hospitals. Questions covered use of technical interventions to prevent CLABSI (eg, alcohol-containing chlorhexidine gluconate [CHG] for skin antisepsis, use of coated catheters), socio-adaptive interventions (eg, feedback of CLABSI rates, use of appropriateness criteria), and leadership support for CLABSI prevention.

Results:

Survey response rate was 47% (415/881). Technical interventions such as maximal sterile barriers (99%) or CHG-impregnated dressings (92%) were highly prevalent, but routine use of CHG bathing was less common (68% indicated regular use in intensive care unit [ICU] vs 18% in non-ICU settings). Although 97% of respondents indicated use of systems to monitor CLABSI, feedback to providers on CLABSI events was reported by 89%. Only 53% of respondents indicated regular use of tools to determine appropriateness of central venous catheters (CVC). Three-quarters of respondents indicated their hospital assessed CVC necessity daily, but only 23% reported strategies to reduce routine blood cultures. CLABSI prevention was extremely important to hospital leadership at 82% of responding hospitals.

Conclusions:

Most US hospitals continue to use evidence-based methods to prevent CLABSI as recommended by leading organizations. Opportunities to focus on socio-adaptive interventions such as feedback of infection rates, use of appropriateness criteria for CVC placement, and improving the “culture of pan-culturing” remain.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 5
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Current HAI progress report. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/portal/progress-report.html. Published 2022. Accessed January 18, 2024.Google Scholar
Shekelle, P, Wachter, R, Pronovost, P, et al. Making health care safer II: an updated critical analysis of the evidence for patient safety practices. National Library of Medicine website. https://www.ncbi.nlm.nih.gov/books/NBK133363/. Published 2013. Accessed January 18, 2024.Google Scholar
Buetti, N, Marschall, J, Drees, M, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol 2022;43:553–569.CrossRefGoogle ScholarPubMed
Weiner-Lastinger, LM, Pattabiraman, V, Konnor, RY, et al. The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: a summary of data reported to the National Healthcare Safety Network. Infect Control Hosp Epidemiol 2021;43:12–25.CrossRefGoogle Scholar
Evans, ME, Simbartl, LA, Kralovic, SM, et al. Healthcare-associated infections in Veterans Affairs acute-care and long-term healthcare facilities during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2023;44:420–426.CrossRefGoogle ScholarPubMed
Chopra, V, Flanders, SA, Saint, S, et al. The Michigan appropriateness guide for intravenous catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med 2015;163:S1–S40.CrossRefGoogle ScholarPubMed
Saint, S, Kowalski, CP, Kaufman, SR, et al. Preventing hospital-acquired urinary tract infection in the United States: a national study. Clin Infect Dis 2008;46:243–250.CrossRefGoogle ScholarPubMed
Krein, SL, Kowalski, CP, Hofer, TP, Saint, S. Preventing hospital-acquired infections: a national survey of practices reported by U.S. hospitals in 2005 and 2009. J Gen Intern Med 2012;27:773–779.CrossRefGoogle ScholarPubMed
Krein, SL, Fowler, KE, Ratz, D, Meddings, J, Saint, S. Preventing device-associated infections in US hospitals: national surveys from 2005 to 2013. BMJ Qual Safety 2015;24:385–392.CrossRefGoogle ScholarPubMed
Saint, S, Greene, MT, Fowler, KE, et al. What US hospitals are currently doing to prevent common device-associated infections: results from a national survey. BMJ Qual Saf 2019;28:741–749.CrossRefGoogle ScholarPubMed
Dillman, DA. Mail and internet surveys: the tailored design method. 2nd ed. New York, NY: Wiley; 2007.Google Scholar
Harris, PA, Taylor, R, Minor, BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019;95:103208.CrossRefGoogle ScholarPubMed
Wang, H, Tong, H, Liu, H, et al. Effectiveness of antimicrobial-coated central venous catheters for preventing catheter-related blood-stream infections with the implementation of bundles: a systematic review and network meta-analysis. Ann Intensive Care 2018;8:71.CrossRefGoogle ScholarPubMed
Chong, HY, Lai, NM, Apisarnthanarak, A, Chaiyakunapruk, N. Comparative efficacy of antimicrobial central venous catheters in reducing catheter-related bloodstream infections in adults: abridged cochrane systematic review and network meta-analysis. Clin Infect Dis 2017;64:S131–S140.CrossRefGoogle ScholarPubMed
Saint, S, Greene, MT, Krein, SL, et al. What US hospitals are doing to prevent common device-associated infections during the coronavirus disease 2019 (COVID-19) pandemic: Results from a national survey in the United States. Infect Control Hosp Epidemiol 2023;44:1913–1919.CrossRefGoogle ScholarPubMed
Chopra, V, Shojania, KG. Recipes for checklists and bundles: one part active ingredient, two parts measurement. BMJ Qual Saf 2012;22:93–96.CrossRefGoogle ScholarPubMed
Frost, SA, Alogso, M-C, Metcalfe, L, et al. Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. Crit Care 2016;20:379.CrossRefGoogle ScholarPubMed
Timsit, J-F, Baleine, J, Bernard, L, et al. Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care 2020;10:118.CrossRefGoogle ScholarPubMed
Machin, M, Liu, C, Coupland, A, Davies, AH, Thapar, A. Systematic review of the use of cyanoacrylate glue in addition to standard wound closure in the prevention of surgical site infection. Int Wound J 2019;16:387–393.CrossRefGoogle ScholarPubMed
Destine, Y, Capes, K, Reynolds, SS. Reduction in patient refusal of CHG bathing. Am J Infect Control 2023;51:1034–1037.CrossRefGoogle ScholarPubMed
Reynolds, SS, Woltz, P, Keating, E, et al. Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial. Implement Sci 2021;16:45.CrossRefGoogle ScholarPubMed
Reynolds, SS, Granger, BB, Hatch, D. Self-Reported versus observed audit: Measuring CHG bathing compliance. Am J Infect Control 2021;49:1575–1577.CrossRefGoogle ScholarPubMed
Fakih, MG, Khatib, R. Improving the culture of culturing: critical asset to antimicrobial stewardship. Infect Control Hosp Epidemiol 2016;38:377–379.CrossRefGoogle ScholarPubMed
Vaughn, VM, Chopra, V. Revisiting the panculture. BMJ Qual Saf 2016;26:236–239.CrossRefGoogle ScholarPubMed
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