Central Line Bundle Implementation in US Intensive Care Units and Impact on Bloodstream Infections

Furuya, E. Yoko; Dick, Andrew W.; Perencevich, Eli N.; Pogorzelska, Monika; Goldmann, Donald A.; Stone, Patricia W.

doi:10.1371/journal.pone.0015452

Cited by 197 publications

(168 citation statements)

References 24 publications

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“…We observed that nine studies (60%) had adult population as their target audience (9,(17)(18)(22)(23)25) , two of them (13,3%) were carried out with children (5,24) , three of them (20%) with newborns (15)(16)20) , and one of them (6,7%) with both populations, in pediatric and neonatology units (14) . Eight of them (53,3%) were developed in the USA (6,9,(15)(16)18,(22)(23)25) and only three (20%) were developed in Latin America, two of them in Brazil (20)(21) and one in Colombia (14) .…”

Section: Resultsmentioning

confidence: 99%

“…Eight of them (53,3%) were developed in the USA (6,9,(15)(16)18,(22)(23)25) and only three (20%) were developed in Latin America, two of them in Brazil (20)(21) and one in Colombia (14) .…”

Section: Resultsmentioning

confidence: 99%

“…Articles analysis regarding the type of bundle methodology described showed that they were composed of at least three and at most six interventions and the majority of the prospective studies presented statistically significant results regarding CRBSI and CLABSI reduction, being CLABSI the object of study in most of the articles (9,(15)(16)(19)(20)(21)(22)25) . Table 1 presents the summary of the interventions described as bundle elements and the number of times that each strategy was listed in the fifteen analyzed articles.…”

Section: Resultsmentioning

confidence: 99%

“…Hands hygiene, a practice universally known as one the main prevention measures against nosocominal infection was mentioned in most of the studies (5)(6)9,(14)(15)(16)(17)(19)(20)(22)(23)(24)(25). Staff education on the need of proper hand sanitation at the moment of inserting, handling or checking CVC was one of the strategies mentioned in order to increase professional adhesion.…”

Section: Resultsmentioning

confidence: 99%

“…It is important to emphasize that, in order to guarantee better results, it is necessary to have a high adhesion to bundle and the proposed guidelines must be jointly and uniformly applied to all patients, becoming a powerful tool for the safety culture (25) .…”

Section: Defining Bundlementioning

confidence: 99%

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Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa

Brachine¹,

Peterlini

Pedreira

2012

Rev. Gaúcha Enferm.

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Trata-se de uma revisão integrativa da literatura, que objetivou identificar intervenções baseadas em evidência que compõem o método bundle, designados à redução de infecção de corrente sanguínea relacionada ou associada a cateter intravenoso central. Para a coleta de dados online, em bases nacionais e internacionais, foram utilizados a palavra-chave bundle e os descritores catheter-related infection, infection control e central venous catheterization, resultando, após aplicação dos critérios de inclusão, amostra de quinze artigos. Este trabalho evidenciou cinco intervenções como as mais frequentemente empregadas na construção dos bundles: higienização das mãos, gluconato de clorexidina como antisséptico para pele, uso de barreira máxima de precaução durante a inserção cateter, evitar acessar veia femoral e verificar necessidade diária de permanência do cateter, com sua remoção imediata quando não mais indicado. A maioria dos estudos demonstrou resultados estatisticamente significantes na redução de infecção de corrente sanguínea relacionada ou associada a cateter intravenoso central.

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Section: Resultsmentioning

confidence: 99%

“…Eight of them (53,3%) were developed in the USA (6,9,(15)(16)18,(22)(23)25) and only three (20%) were developed in Latin America, two of them in Brazil (20)(21) and one in Colombia (14) .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Defining Bundlementioning

confidence: 99%

See 3 more Smart Citations

Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa

Brachine¹,

Peterlini

Pedreira

2012

Rev. Gaúcha Enferm.

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Effect of Medicare’s Nonpayment for Hospital-Acquired Conditions

et al. 2015

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IMPORTANCEIn 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied.OBJECTIVE To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. DESIGN, SETTING, AND PARTICIPANTSQuasi-experimental study of adult nursing units from 1381 US hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a program of the American Nurses Association. The NDNQI data were combined with American Hospital Association, Medicare Cost Report, and local market data to examine adjusted outcomes. Multilevel models were used to evaluate the effect of Medicare's nonpayment policy on never events.EXPOSURES United States hospitals providing treatment for Medicare patients were subject to the new payment policy beginning in October 2008. MAIN OUTCOMES AND MEASURESChanges in unit-level rates of HAPUs, injurious falls, CLABSIs, and CAUTIs after initiation of the policy. RESULTS Medicare's nonpayment policy was associated with an 11% reduction in the rate of change in CLABSIs (incidence rate ratio [IRR], 0.89; 95% CI, 0.83-0.95) and a 10% reduction in the rate of change in CAUTIs (IRR, 0.90; 95% CI, 0.85-0.95), but was not associated with a significant change in injurious falls (IRR, 0.99; 95% CI, 0.99-1.00) or HAPUs (odds ratio, 0.98; 95% CI, 0.96-1.01). Consideration of unit-, hospital-, and market-level factors did not significantly alter our findings. CONCLUSIONS AND RELEVANCEThe HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative was not associated with improvements in HAPU or injurious fall trends, conditions for which there is less evidence that changing hospital processes leads to significantly better outcomes.

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Health Care–Associated Infections Among Critically Ill Children in the US, 2013-2018

et al. 2020

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IMPORTANCE Central catheter-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) increase morbidity, mortality, and health care costs in pediatric patients. OBJECTIVE To examine changes over time in CLABSI and CAUTI rates between 2013 and 2018 in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) using prospective surveillance data from community hospitals, children's hospitals, and pediatric units within general hospitals. DESIGN, SETTING, AND PARTICIPANTSThis time series study included 176 US hospitals reporting pediatric health care-associated infection surveillance data to the National Healthcare Safety Network from January 1, 2013, to June 30, 2018. Patients aged 18 years or younger admitted to PICUs or level III NICUs were included in the analysis. MAIN OUTCOMES AND MEASURESThe primary outcomes were device-associated rates of CLABSI in NICUs and PICUs and CAUTI in PICUs (infections per 1000 device-days). Secondary outcomes included population-based rates (infections per 10 000 patient-days) and device utilization (device-days per patient-days). Regression models were fit using generalized estimating equations to assess yearly changes in CLABSI and CAUTI rates, adjusted for birth weight (Յ1500 vs >1500 g) in neonatal models. RESULTSOf the 176 hospitals, 132 hospitals with NICUs and 114 hospitals with PICUs contributed data. Of these, NICUs reported 6 064 172 patient-days and 1 363 700 central line-days and PICUs reported 1 999 979 patient-days, 925 956 central catheter-days, and 327 599 indwelling urinary catheter-days. In NICUs, there were no significant changes in yearly trends in device-associated (incidence rate ratio [IRR] per year, 0.99; 95% CI, 0.95-1.03) and population-based (IRR, 0.96; 95% CI, 0.92-1.00) CLABSI rates or central catheter utilization (odds ratio [OR], 0.97; 95% CI, 0.95-1.00). Results were similar in PICUs, with device-associated (IRR, 1.03; 95% CI, 0.99-1.07) and population-based (IRR, 1.03; 95% CI, 0.99-1.07) CLABSI rates and central catheter utilization (OR, 0.99; 95% CI, 0.97-1.01) remaining stable. While device-associated CAUTI rates in PICUs also remained unchanged over time (IRR, 0.97; 95% CI, 0.91-1.03), population-based CAUTI rates significantly decreased by 8% per year (IRR, 0.92; 95% CI, 0.86-0.98) and indwelling urinary catheter utilization significantly decreased by 6% per year (OR, 0.94; 95% CI, 0.91-0.96). CONCLUSIONS AND RELEVANCERecent trends in CLABSI rates noted in this study among critically ill neonates and children in a large cohort of US hospitals indicate that past gains have held, without evidence of further improvements, suggesting novel approaches for CLABSI prevention are needed. Modest improvements in population-based CAUTI rates likely reflect more judicious use of urinary catheters.

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Central Line Bundle Implementation in US Intensive Care Units and Impact on Bloodstream Infections

Cited by 197 publications

References 24 publications

Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa

Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa

Effect of Medicare’s Nonpayment for Hospital-Acquired Conditions

Health Care–Associated Infections Among Critically Ill Children in the US, 2013-2018

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