Reduction of central-line-associated bloodstream infection (CLABSI) in resource limited, nonintensive care unit (ICU) settings

Poh, Kok Wei; Ngan, Cheng Huong; Wong, Ji Yin; Ng, Tiang Koi; Noor, Nadiah Mohd

doi:10.1108/ijhcqa-11-2019-0195

Cited by 3 publications

(3 citation statements)

References 52 publications

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“…Of these patients with detected AEs, 83% were subject to 1 AE during their stay, 11% subject to 2 AEs, and 6% were subject to at least 3 AEs. Hb drop more than 25% 1 Ventilator-associated pneumonia All inpatient on ventilators ICU (20.7-27.1/1000 device days) [48][49][50][51][52][53][54] Ventilation days: 2970 61.5-80.5 (mean, 71.0) 57 70.8%-92.6% (mean, 80%) Positive respiratory cultures 56 On average, 10 minutes was required to discuss each case by the team, and 25 minutes to discuss the case with the consensus panel. For all triggered cases, the primary data collection for case investigation was performed while the patients were still hospitalized.…”

Section: Resultsmentioning

confidence: 99%

“…The sensitivity level was estimated by the ratio of the system’s detected AEs per harm subcategory, to an estimated total number of AE cases for that subcategory. This estimate was extrapolated from incidence studies in the literature targeting the corresponding subcategory, 31–54 after the application to the corresponding included hospital population (Table 4).…”

Section: Methodsmentioning

confidence: 99%

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Automated Detection of Patient Harm: Implementation and Prospective Evaluation of a Real-Time Broad-Spectrum Surveillance Application in a Hospital With Limited Resources

et al. 2023

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Objectives: This study aimed to prospectively validate an application that automates the detection of broad categories of hospital adverse events (AEs) extracted from a basic hospital information system, and to efficiently mobilize resources to reduce the level of acquired patient harm.Methods: Data were collected from an internally designed software, extracting results from 14 triggers indicative of patient harm, querying clinical and administrative databases including all inpatient admissions (n = 8760) from October 2019 to June 2020. Representative samples of the triggered cases were clinically validated using chart review by a consensus expert panel. The positive predictive value (PPV) of each trigger was evaluated, and the detection sensitivity of the surveillance system was estimated relative to incidence ranges in the literature. Results:The system identified 394 AEs among 946 triggered cases, associated with 291 patients, yielding an overall PPVof 42%. Variability was observed among the trigger PPVs and among the estimated detection sensitivities across the harm categories, the highest being for the healthcare-associated infections. The median length of stay of patients with an AE showed to be significantly higher than the median for the overall patient population. Conclusions:This application was able to identify AEs across a broad spectrum of harm categories, in a real-time manner, while reducing the use of resources required by other harm detection methods. Such a system could serve as a promising patient safety tool for AE surveillance, allowing for timely, targeted, and resource-efficient interventions, even for hospitals with limited resources.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Automated Detection of Patient Harm: Implementation and Prospective Evaluation of a Real-Time Broad-Spectrum Surveillance Application in a Hospital With Limited Resources

et al. 2023

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“…It is widely accepted that programmes, such as catheter care bundles, are crucial for preventing catheter-related complications especially CLABSI ( 27 – 30 ). Most hospitals in Malaysia, including our centre, implemented the programme more than 5 years ago.…”

Section: Discussionmentioning

confidence: 99%

Peripherally Inserted Central Venous Catheter-Related Complications in Adult Patients with Haematological Malignancy

Kee Wei,

Chin Sum,

Gin Gin

2024

MJMS

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Background: Peripherally inserted central venous catheters (PICC) are widely used in patients with haematological malignancies owing to the requirement for prolonged intravenous therapy. However, the growing use of PICCs has resulted in a multitude of complications such as infections and thrombosis, leading to prolonged hospitalisation periods and increased morbidity. This study aimed to determine the incidence of and factors associated with PICC-related complications in patients with haematological malignancies. Methods: This prospective cohort study was conducted at a single academic institution. The inclusion criteria involved all adult patients with haematological malignancies who had newly inserted PICCs. The patients were observed for a minimum duration of 60 days to evaluate the incidence of PICC-related infections and thrombosis, as well as mechanical complications. Results: A total of 119 PICCs were implanted in 85 patients. Among them, more than half of the patients were diagnosed with lymphoma (55.0%). The median dwell time was 61 days (interquartile range: 98 days). The incidence of PICC-related complications was 58.0% (6.9 per 1,000 catheter-days). Specifically, 43 PICCs (36.1%, 4.3 per 1,000 catheter-days) experienced infective complications, 25 (21.1%, 2.5 per 1,000 catheter-days) encountered mechanical complications and 1 (0.8%, 0.1 per 1,000 catheter-days) exhibited thrombotic complications. Furthermore, an underlying diagnosis of acute leukaemia was significantly associated with a higher incidence of PICC-related infections. Conclusion: Our study revealed higher incidence rates of PICC-related complications in adult patients with haematological malignancies compared to the finding of other studies. Notably, patients with underlying acute leukaemia displayed a higher incidence of PICC-related infections. These findings underscore the importance of implementing appropriate interventions and conducting thorough root cause analyses to effectively mitigate this complication and improve patient outcomes.

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Reducing Central-Line–Associated Bloodstream Infections (CLABSI): An Improvement Project in a Specialized Tertiary Hospital

Mostafa

Alnafee

Shanqiti

et al. 2022

Global Journal on Quality and Safety in Healthcare

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Introduction Central-line–associated bloodstream infections (CLABSI) are preventable hospital-acquired infections that harm and prolong a patient's hospital stay and increase unnecessary hospital expenditure. In collaboration with infection control and hospital epidemiology, the quality management department initiated a performance improvement project to address 144 CLABSI events in 2017. Methods The performance improvement project team used brainstorming to create change ideas presented in a driver diagram. The team then applied plan-do-study-act (PDSA) cycles to implement and monitor the improvements. Finally, the team applied a bundle of interventions that included the following: (a) policies and procedures for central line insertion, maintenance and removal processes standardization, (b) physicians training for line insertion by simulation, (c) an awareness campaign that included recognizing healthcare workers and enhancing patient engagement, (d) performing root cause analysis for the CLABSI events, and (e) automation of central line insertion, and (f) maintenance bundles documentation in the hospital information system. Results The CLABSI rate per 1000 patient days dropped from 1.5 per 1000 device days to 1.03 per 1000 device days. In addition, CLABSI events reduction was 24% by 2018. Then further reduction of 15% occurred by the end of 2019. Thus, the overall decrease in CLABSI events was 35% from the baseline number of events (i.e., 144 events) in 2017. Another achievement of the project is that 10 units reported zero CLABSI events in 2018 and 2019, of which four units had a high central line utilization rate, more than 40%. Conclusion The implemented interventions effectively reduced the CLABSI events in the hospital. The project team will continue implementing more interventions with monitoring, aiming to achieve zero CLABSIs over time in all the hospital units.

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Reduction of central-line-associated bloodstream infection (CLABSI) in resource limited, nonintensive care unit (ICU) settings

Cited by 3 publications

References 52 publications

Automated Detection of Patient Harm: Implementation and Prospective Evaluation of a Real-Time Broad-Spectrum Surveillance Application in a Hospital With Limited Resources

Automated Detection of Patient Harm: Implementation and Prospective Evaluation of a Real-Time Broad-Spectrum Surveillance Application in a Hospital With Limited Resources

Peripherally Inserted Central Venous Catheter-Related Complications in Adult Patients with Haematological Malignancy

Reducing Central-Line–Associated Bloodstream Infections (CLABSI): An Improvement Project in a Specialized Tertiary Hospital

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