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Preventing nosocomial bloodstream infections (NBSIs) by implementing hospitalwide, department-level, self-investigations: A NBSIs frontline ownership intervention
Published online by Cambridge University Press: 08 March 2023
Abstract
Background:
Nosocomial bloodstream infections (NBSIs) are adverse complications of hospitalization. Most interventions focus on intensive care units. Data on interventions involving patients’ personal care providers in hospitalwide settings are limited.
Objective:
To evaluate the impact of department-level NBSI investigations on infection incidence.
Methods:
Beginning in 2016, positive cultures, classified as suspected of being hospital acquired, were prospectively investigated by patients’ unit-based personal healthcare providers using a structured electronic questionnaire. After analyzing the conclusions of the investigation, a summary was sent quarterly to the departments and to hospital management. NBSI rates and clinical data during a 5-year period (2014–2018) were calculated and compared before and after the intervention (2014–2015 versus 2016–2018), using interrupted time-series analysis.
Results:
Among 4,135 bloodstream infections (BSIs), 1,237 (30%) were nosocomial. The rate of NBSI decreased from 4.58 per 1,000 admissions days in 2014 and 4.82 in 2015, to 3.81 in 2016, 2.94 in 2017 and 2.86 in 2018. Following a 4-month lag after introducing the intervention, the NBSI rate per 1000 admissions dropped significantly by 1.33 (P = .04; 95% CI, −2.58 to −0.07). The monthly NBSI rate continued to decrease significantly by 0.03 during the intervention period (P = .03; 95% CI, −0.06 to −0.002).
Conclusions:
Detailed department-level investigations of NBSI events performed by healthcare providers, increased staff awareness and frontline ownership and were associated with a decrease in NBSI rates hospitalwide.
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- Original Article
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- Copyright
- © The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
References
Prevention of hospital-acquired infections—a practical guide, second edition. World Health Organization website. https://apps.who.int/iris/bitstream/handle/10665/67350/WHO_CDS_CSR_EPH_2002.12.pdf. Published 2002. Accessed January 27, 2023.Google Scholar
Edmond, MB, Wallace, SE, McClish, DK, Pfaller, MA, Jones, RN, Wenzel, RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999;29:239–244.CrossRefGoogle ScholarPubMed
Bloodstream infection event (central-line–associated bloodstream infection and non–central-line–associated bloodstream infection). Center for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf. Published 2016. Accessed January 27, 2023.Google Scholar
Wenzel, RP, Edmond, MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis 2001;7:174–177.CrossRefGoogle ScholarPubMed
Septimus, EJ, Moody, J. Prevention of device-related healthcare-associated infections. F1000Research 2016;5:65.10.12688/f1000research.7493.1CrossRefGoogle ScholarPubMed
Chen, S, O’Malley, M, Chopra, V. How common are indwelling devices in hospitalized adults? A contemporary point-prevalence study in a tertiary-care hospital. Am J Infect Control 2021;49:194–197.CrossRefGoogle ScholarPubMed
Kallen, AJ, Patel, PR, O’Grady, NP. Preventing catheter-related bloodstream infections outside the intensive care unit: expanding prevention to new settings. Clin Infect Dis 2010;51:335–341.CrossRefGoogle ScholarPubMed
Reunes, S, Rombaut, V, Vogelaers, D, et al. Risk factors and mortality for nosocomial bloodstream infections in elderly patients. Eur J Intern Med 2011;22:e39–e44.CrossRefGoogle ScholarPubMed
Lyytikäinen, O, Lumio, J, Sarkkinen, H, Kolho, E, Kostiala, A, Ruutu, P. Nosocomial bloodstream infections in Finnish hospitals during 1999–2000. Clin Infect Dis 2002;35(2):e14–e19.CrossRefGoogle ScholarPubMed
Schrank, GM, Sick-Samuels, A, Bleasdale, SC, et al. Development and evaluation of a structured guide to assess the preventability of hospital-onset bacteremia and fungemia. Infect Control Hosp Epidemiol 2022;43:1326–1332.CrossRefGoogle ScholarPubMed
Dantes, RB, Rock, C, Milstone, AM, et al. Preventability of hospital-onset bacteremia and fungemia: a pilot study of a potential healthcare-associated infection outcome measure. Infect Control Hosp Epidemiol 2019;40:358–361.CrossRefGoogle ScholarPubMed
Yu, KC, Ye, G, Edwards, JR, et al. Hospital-onset bacteremia and fungemia: an evaluation of predictors and feasibility of benchmarking comparing two risk-adjusted models among 267 hospitals. Infect Control Hosp Epidemiol 2022;43:1317–1325.CrossRefGoogle ScholarPubMed
Goto, M, Al-Hasan, MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect 2013;19:501–509.CrossRefGoogle ScholarPubMed
Leekha, S, Li, S, Thom, KA, et al. Comparison of total hospital-acquired bloodstream infections to central-line–associated bloodstream infections and implications for outcome measures in infection control. Infect Control Hosp Epidemiol 2013;34:984–986.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network (NHSN) commensal list. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/vsalidation/2019/2019-NHSN-Organisms-List-Validation.xlsx. Published 2022. Accessed January 27, 2023.Google Scholar
2018 National and state healthcare-associated infections progress report. Centers for Disease Control and Prevention website. http://www.cdc.gov/HAI/pdfs/progress-report/hai-progress-report.pdf. Published 2018. Accessed November 5, 2020.Google Scholar
Chopra, V, Govindan, S, Kuhn, L, et al. Do clinicians know which of their patients have central venous catheters? Ann Intern Med 2014;161:562.CrossRefGoogle ScholarPubMed
Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.CrossRefGoogle ScholarPubMed
Jarvis, WR, Cookson, ST, Robles, MB. Prevention of nosocomial bloodstream infections: a national and international priority. Infect Control Hosp Epidemiol 1996;17:272–275.CrossRefGoogle ScholarPubMed
Scheckler, WE, Brimhall, D, Buck, AS, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Am J Infect Control 1998;26:47–60.CrossRefGoogle ScholarPubMed
Wisplinghoff, H, Bischoff, T, Tallent, SM, Seifert, H, Wenzel, RP, Edmond, MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309–317.CrossRefGoogle ScholarPubMed
Correa, L, Pittet, D. Problems and solutions in hospital-acquired bacteremia. J Hosp Infect 2000;46:89–95.CrossRefGoogle Scholar
Mudrik-Zohar et al. supplementary material
Mudrik-Zohar et al. supplementary material
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