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

Abstract

BackgroundWe 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.MethodsThis 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.ResultsSignificantly 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.ConclusionsOur 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.

Belgian hand hygiene campaigns in ICU, 2005–2015

“…This could be attributed to the introduction of online tool with real time feedback at hospital and service levels. A study conducted in 2013 in Belgium in the ICU on the impact of auditing and feedback in preventing central line infections showed that results were best in services where nurses participated once a week at a feedback meeting [24]. This study therefore supports our results showing that feedback in visual form combined with oral presentations are important in improving compliance and fight against healthcare associated infections.…”

Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): results of a worldwide survey

“…Despite most of the respondents agreeing that measurement is essential for improvement, and routinely counting CLABSI, only few were able to report the actual CLABSI rate in their unit. Our findings are comparable to several other studies or surveys conducted on CLABSI prevention practices in ICU’s at local level [21–23]. A survey assessing implementation of preventive CLABSI measures and monitoring of compliance to these measures, identified that the use of full body drape during CVC insertion was among the measures less applied.…”

Impacto Da Implementação Dos Bundles Na Redução Das Infecções Da Corrente Sanguínea: Uma Revisão Integrativa

“…The measures implemented in the CVC insertion bundle were: maximal sterile barrier precautions; (use of sterile gloves, cap, mask, apron and sterile field -94% of studies); 12,14,17-25,27-30 skin asepsis (94%), 12,14,[17][18][19][20][21][22][23][24][25][27][28][29][30] hand hygiene before insertion (62%), 14,19,21,[23][24][25][26][27][28] preference for the subclavian vein (44%), 12,14,17,18,21,22,27 avoiding femoral vein (37%), 17,18,20,24,25,28 immediate removal of CVC without clinical indication for its use (37%), 18,19,21,24,26.28 ultrasound to guide the insertion of the catheter (19%); 14,17,21 allow the antiseptic to dry before inserting the catheter (12%); 23,30 CVC impregnated with antibiotic (12%); The CVC was inserted without aseptic techniques within 48 hours (12%), 17,21 and only designated qualified professionals to insert the CVC (12%).…”

“…The maintenance bundle comprised: daily verification of the need for CVC permanence (87%), 12,14,20,22,25,29,30 disinfection of the hub before administering medications (62%), 18,20,22,25,30 monitor the insertion site (50%), 18,22,29,30 dressing replacement with sterile gauze every two days and transparent dressing every 7 days or whenever they are dirty, loose or moist (50%); 18,20,25,30 hygiene of the hands before handling (37%), 18,20,25 and asepsis of the skin when changing the dressing (25%). Other measures that also made up the bundle were mentioned in the articles, being: training and continuing education to professionals who insert and manipulate the CVC in 56% 17,19,24,[25][26][27][28][29][30] and feedback of the results, indicated in 31%.…”

“…14,19 Although it is not the objective of this study, it is highlighted that agents related to the cause of CVD bloodstream infections were described in only 31% of the studies, including: Negative-Coagulase Staphylococcus, Staphylococcus aureus, Enterococcus spp, Klebsiella Pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Candida spp. 12,17,20,23,25 In the studies, 19 measures that compose bundles to prevent CVC-related bloodstream infections were found in the studies. Of these, 11 were used for catheter insertion, six during maintenance and two in continuing education and feedback of the results as a global part of the process.…”