Impact of Switching from an Open to a Closed Infusion System on Rates of Central Line–Associated Bloodstream Infection: A Meta-analysis of Time-Sequence Cohort Studies in 4 Countries

Maki, Dennis G.; Rosenthal, Víctor D.; Salomão, Reinaldo; Franzetti, Fabio; Rangel‐Frausto, M. Sigfrido

doi:10.1086/657632

Cited by 27 publications

(31 citation statements)

References 52 publications

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“…7,8,14 More recently, closed infusion containers have been shown to reduce the risk of central line-associated BSI compared with open systems. [15][16][17] Similarly, patients receiving premixed parenteral nutrition solutions have been shown to have a substantially reduced risk of BSI relative to those receiving traditionally compounded parenteral nutrition. 18 Whether or not other delivery systems that limit manual admixture of drug and solution have a beneficial impact on BSI rates has not been extensively examined.…”

Section: Discussionmentioning

confidence: 99%

Comparative risk of bloodstream infection in hospitalized patients receiving intravenous medication by open, point-of-care, or closed delivery systems

Mercaldi¹,

Lanes²,

Bradt

2013

American Journal of Health-System Pharmacy

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Section: Discussionmentioning

confidence: 99%

Comparative risk of bloodstream infection in hospitalized patients receiving intravenous medication by open, point-of-care, or closed delivery systems

Mercaldi¹,

Lanes²,

Bradt

2013

American Journal of Health-System Pharmacy

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“…Use of closed collapsible flexible containers instead of open semi-rigid vented or glass vented IV containers [19]. …”

Section: Methodsmentioning

confidence: 99%

Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

Leblebicioğlu

Öztürk

Rosenthal³

et al. 2013

Ann Clin Microbiol Antimicrob

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BackgroundCentral line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey.MethodsWe conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention.ResultsDuring baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 – 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB.ConclusionsThe implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.

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“…Central lines increase the risk of bloodstream infections. [12,13] Known risk factors for CLABSI include administration of TPN, [12,13] frequent manipulation of the line, [14] open vascular systems, [15] not using needleless connections [6] and the use of multiple access ports. [6] Conflicting data exist on which type of central line is associated with the highest risk for CLABSI and when prolonged catheter dwell time becomes a risk factor.…”

Section: Researchmentioning

confidence: 99%

Central-line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit

et al. 2017

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Background. The rate of central-line-associated bloodstream infection (CLABSI) in South African (SA) public sector neonatal intensive care units (NICUs) is unknown. Tygerberg Children's Hospital (TCH), Cape Town, introduced a neonatal CLABSI surveillance and prevention programme in August 2012. Objectives. To describe CLABSI events and identify risk factors for development of CLABSI in a resource-limited NICU. Methods. A retrospective case-control study was conducted using prospectively collected NICU CLABSI events matched to four randomly selected controls, sampled from the NICU registry between 9 August 2012 and 31 July 2014. Clinical data and laboratory records were reviewed to identify possible risk factors, using stepwise forward logistic regression analysis. Results. A total of 706 central lines were inserted in 530 neonates during the study period. Nineteen CLABSI events were identified, with a CLABSI rate of 5.9/1 000 line days. CLABSI patients were of lower gestational age (28 v. 34 weeks; p=0.003), lower median birth weight (1 170 g v. 1 975 g; p=0.014), had longer catheter dwell times (>4 days) (odds ratio (OR) 5.1 (95% confidence interval (CI) 1.0 -25.4); p=0.04) and were more likely to have had surgery during their NICU stay (OR 3.5 (95% CI 1.26 -10); p=0.01). Significant risk factors for CLABSI were length of stay >30 days (OR 20.7 (95% CI 2.1 -203.2); p=0.009) and central-line insertion in the operating theatre (OR 8.1 (95% CI 1.2 -54.7); p=0.03). Gram-negative pathogens predominated (12/22; 54%), with most isolates (10/12; 83%) exhibiting multidrug resistance. Conclusion. The TCH NICU CLABSI rate is similar to that reported from resource-limited settings, but exceeds that of high-income countries. Prolonged NICU stay and central-line insertion in the operating theatre were important risk factors for CLABSI development. Intensified neonatal staff training regarding CLABSI maintenance bundle elements and hand hygiene are key to reducing CLABSI rates.

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Impact of Switching from an Open to a Closed Infusion System on Rates of Central Line–Associated Bloodstream Infection: A Meta-analysis of Time-Sequence Cohort Studies in 4 Countries

Cited by 27 publications

References 52 publications

Comparative risk of bloodstream infection in hospitalized patients receiving intravenous medication by open, point-of-care, or closed delivery systems

Comparative risk of bloodstream infection in hospitalized patients receiving intravenous medication by open, point-of-care, or closed delivery systems

Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

Central-line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit

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