Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-23T21:06:29.278Z Has data issue: false hasContentIssue false
  • English
  • Français

The association between implementation of second-tier prevention practices and CLABSI incidence: A national survey

Published online by Cambridge University Press:  24 July 2019

Debby Ben-David Open the ORCID record for Debby Ben-David [Opens in a new window] ,
Azza Vaturi ,
Ester Solter ,
Elizabeth Temkin ,
Yehuda Carmeli ,
Mitchell J. Schwaber  and
the Israel CLABSI Prevention Working Group
Debby Ben-David*
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Israel
Azza Vaturi
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Israel
Ester Solter
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Israel
Elizabeth Temkin
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Israel
Yehuda Carmeli
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Israel Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
Mitchell J. Schwaber
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Israel Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
the Israel CLABSI Prevention Working Group
Affiliation:
National Center for Infection Control, Israel Ministry of Health, Israel Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
*
Author for correspondence: Debby Ben-David, MD, National Center for Infection Control, 6 Weizmann St, Tel Aviv 6423906 Israel. E-mail: debbybd@tlvmc.gov.il
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Prevention of central-line–associated bloodstream infection (CLABSI) represents a complex challenge for the teams involved in device insertion and maintenance. First-tier practices for CLABSI prevention are well established.

Objective:

We describe second-tier prevention practices in Israeli medical-surgical ICUs and assess their association with CLABSI rates.

Methods:

In June 2017, an online survey assessing infection prevention practices in general ICUs was sent to all Israeli acute-care hospitals. The survey comprised 14 prevention measures supplementary to the established measures that are standard of care for CLABSI prevention. These measures fall into 2 domains: technology and implementation. The association between the number of prevention measures and CLABSI rate during the first 6 months of 2017 was assessed using Spearman’s correlation. We used negative binomial regression to calculate the incidence rate ratio (IRR) associated with the overall number of prevention measures and with each measure individually.

Results:

The CLABSI rates in 24 general ICUs varied between 0.0 and 17.0 per 1,000 central-line days. Greater use of preventive measures was associated with lower CLABSI rates (ρ, –0.70; P < .001). For each additional measure, the incidence of CLABSI decreased by 19% (IRR, 0.81; 95% CI, 0.73–0.89). Specific measures associated with lower rates were involvement of ward champions (IRR, 0.47; 95% CI, 0.31–0.71), auditing of insertions by infection control staff (IRR, 0.35; 95% CI, 0.19–0.64), and simulation-based training (IRR, 0.38; 95% CI, 0.22–0.64).

Conclusion:

Implementation of second-tier preventive practices was protective against CLABSI. Use of more practices was correlated with lower rates.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 10 , October 2019 , pp. 1094 - 1099
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Members of the Israel CLABSI Prevention Working Group: Alexander Axel RN, MHA (Assuta Medical Centers, Tel Aviv); Shlomo L. Maayan MD, Daniel Jacobson MD, Yael Vilozni RN, MPHA and Vadim Berezovsky MD (Barzilai Medical Center, Ashkelon); Bina Rubinovitch MD and Hefziba Madar RN, MA (Beilinson Hospital, Rabin Medical Center, Petah Tikva); Alona Paz MD (Bnai Zion Medical Center, Haifa); Gabriel Weber MD, Shlomit Izhaki, MA, RN, Shereen Soboh RN, Mira Shitrit RN and Arieh Eden MD (Carmel Medical Center, Haifa); Bibiana Chazan MD, Iris Grinberg Avraham MSc, RN and Aied Abusebeih BSc, RN (Emek Medical Center, Afula); Yael Ziv MD, Alexander Samokhvalov MD, Emil Agha MPH and Elah Talker Rafter MPH (Galilee Medical Center, Nahariya); Tamar Gottesman Yekutieli MD and Rina Fedorowsky, RN, MA (Hasharon Hospital, Rabin Medical Center, Petah Tikva); Shmuel Benenson MD, MSc, Carmela Schwartz RN, MPH and Kami Harpaz RN, MPH (Hadassah-Hebrew University Medical Center, Ein Kerem and Mount Scopus campuses, Jerusalem); Carmela Gweta-Lugassy RN, BSN, MA (Herzliya Medical Center, Herzliya); Aliza Vaknin BA, Michal Stein MD and Orna Ben-Natan PhD (Hillel Yaffe Medical Center, Hadera); Lina Nasrawi RN, MPH (Holy Family Hospital, Nazareth); Pnina Ciobotaro MD, Maly Oved RN, MPA, Elena Kishinevsky MD, Yael Polishuk RN, MPA and Rita Bardenstein MSc (Kaplan Medical Center, Rehovot); Bat-Sheva Kloyzner BA (Mayanei Hayeshua Medical Center, Bnei Brak); Pnina Shitrit MD, Beatriz Gerber RN, Hani Laderman Schumer RN, Ortal Hilel RN and Ofra Benisty RN (Meir Medical Center, Kfar Saba); Hiba Zayyad MD and Kozita Labay MHA, RN (Baruch-Padeh Medical Center, Poriya); Khetam Hussein MD, Halima Dabaja-Younis MD, Orna Eluk RN and Tamar Alon RN (Rambam Medical Center, Haifa); Regev Cohen MD, Shoshana Cohen RN, BA and Marina Afraimov RN, MA (Sanz Medical Center, Laniado Hospital, Netanya); Ronit Nativ MPH, RN and Seada Eskira MPH, RN (Soroka Medical Center, Beer Sheva); Yonit Wiener-Well MD and Liora Bier RN, MA (Shaare Zedek Medical Center, Jerusalem); Dror Marchaim MD, Lili Goldshtein RN, MPH and Dan Klafter RN, BSN, MPH, EMT-P (Shamir Medical Center, Assaf Harofeh campus, Zerifin); Ilana Tal RN, MA and Elena Machtin RN, BA (Sheba Medical Center, Ramat Gan); Meirav Mor MD2, Sigalit Rozenfeld RN, Ester Shmuelov RN and Elhanan Nahum MD2(Schneider Children’s Medical Center of Israel, Petah Tikva); Vered Schechner MD, MSc and Anna Perechododnik RN (Tel Aviv Medical Center, Tel Aviv); Yasmin Maor MD2 and Orly Agmon MN (Wolfson Medical Center, Holon); *Jalal Tarabeia PhD (Faculty of Nursing, The Max Stern Yezreel Valley College; Ziv Medical Center, Zefat) and Miriam Sudri BA (Ziv Medical Center, Zefat).

*

The affiliation for Jalal Tarabeia in the working group has been corrected. A corrigendum notice detailing this change was also published (DOI: 10.1017/ice.2019.272).

References

Olaechea, PM, Palomar, M, Alvarez-Lerma, F, Otal, JJ, Insausti, J, Lopez-Pueyo, MJ. Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients. Rev Esp Quimioter 2013;26:21–29.Google ScholarPubMed
Ziegler, MJ, Pellegrini, DC, Safdar, N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection 2015;43:29–36.CrossRefGoogle ScholarPubMed
Blot, SI, Depuydt, P, Annemans, L, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis 2005;41:1591–1598.CrossRefGoogle ScholarPubMed
Higuera, F, Rangel-Frausto, MS, Rosenthal, VD, et al. Attributable cost and length of stay for patients with central venous catheter-associated bloodstream infection in Mexico City intensive care units: a prospective, matched analysis. Infect Control Hosp Epidemiol 2007;28:31–35.CrossRefGoogle ScholarPubMed
Data summary of HAIs in the United States: assessing progress 2006–2016. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/archive/data-summary-assessing-progress.html. Accessed January 1, 2019.Google Scholar
Bion, J, Richardson, A, Hibbert, P, et al. ‘Matching Michigan’: a 2-year stepped interventional programme to minimise central venous catheter bloodstream infections in intensive care units in England. BMJ Qual Saf. 2013;22:110–123.CrossRefGoogle ScholarPubMed
Hansen, S, Schwab, F, Schneider, S, Sohr, D, Gastmeier, P, Geffers, C. Time-series analysis to observe the impact of a centrally organized educational intervention on the prevention of central-line–associated bloodstream infections in 32 German intensive care units. J Hosp Infect 2014;87:220–226.CrossRefGoogle ScholarPubMed
Van der Kooi, T, Sax, H, Pittet, D, et al. Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections. Intensive Care Med 2018;44:48–60.CrossRefGoogle ScholarPubMed
Ling, ML, Apisarnthanarak, A, Jaggi, N, et al. APSIC guide for prevention of central line associated bloodstream infections (CLABSI). Antimicrob Resist Infect Control 2016;5:16.CrossRefGoogle Scholar
Safdar, N, O’Horo, JC, Ghufran, A, et al. Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis. Crit Care Med 2014;42:1703–1713.CrossRefGoogle ScholarPubMed
Frost, SA, Alogso, MC, Metcalfe, L, et al. Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. Crit Care 2016;20:379.CrossRefGoogle ScholarPubMed
Wright, MO, Tropp, J, Schora, DM, et al. Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. Am J Infect Control 2013;41:33–38.CrossRefGoogle ScholarPubMed
Ista, E, van der Hoven, B, Kornelisse, RF, et al. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. Lancet Infect Dis 2016;16:724–734.CrossRefGoogle ScholarPubMed
Krein, SL, Greene, MT, Apisarnthanarak, A, et al. Infection prevention practices in Japan, Thailand, and the United States: results from national surveys. Clin Infect Dis 2017;64 suppl 2:S105–S111.CrossRefGoogle Scholar
Valencia, C, Hammami, N, Agodi, A, et al. Poor adherence to guidelines for preventing central-line–associated bloodstream infection (CLABSI): results of a worldwide survey. Antimicrob Resist Infect Control 2016;5:49.CrossRefGoogle ScholarPubMed
Furuya, EY, Dick, AW, Herzig, CT, Pogorzelska-Maziarz, M, Larson, EL, Stone, PW. Central line-associated bloodstream infection reduction and bundle compliance in intensive care units: a national study. Infect Control Hosp Epidemiol 2016;37:805–810.CrossRefGoogle ScholarPubMed
Bloodstream infection event (central line-associated bloodstream infection). Centers for Disease Control and Prevention website. www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf. Published 2019. Accessed 8 March 2019.Google Scholar
Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.CrossRefGoogle ScholarPubMed
Shortell, SM, Marsteller, JA, Lin, M, et al. The role of perceived team effectiveness in improving chronic illness care. Med Care 2004;42:1040–1048.CrossRefGoogle ScholarPubMed
Gurses, AP, Murphy, DJ, Martinez, EA, Berenholtz, SM, Pronovost, PJ. A practical tool to identify and eliminate barriers to compliance with evidence-based guidelines. Jt Comm J Qual Patient Saf 2009;35:526–532.Google ScholarPubMed
Damschroder, LJ, Banaszak-Holl, J, Kowalski, CP, Forman, J, Saint, S, Krein, SL. The role of the champion in infection prevention: results from a multisite qualitative study. Qual Saf Health Care 2009;18:434–440.CrossRefGoogle ScholarPubMed
McGaghie, WC, Issenberg, SB, Cohen, ER, Barsuk, JH, Wayne, DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med. 2011;86:706–711.CrossRefGoogle Scholar
Peltan, ID, Shiga, T, Gordon, JA, Currier, PF. Simulation improves procedural protocol adherence during central venous catheter placement: a randomized controlled trial. Simul Healthc. 2015;10:270–276.CrossRefGoogle ScholarPubMed
Khouli, H, Jahnes, K, Shapiro, J, et al. Performance of medical residents in sterile techniques during central vein catheterization: randomized trial of efficacy of simulation-based training. Chest 2011;139:80–87.CrossRefGoogle ScholarPubMed
Barsuk, JH, Cohen, ER, Feinglass, J, McGaghie, WC, Wayne, DB. Use of simulation-based education to reduce catheter-related bloodstream infections. Arch Intern Med 2009;169:1420–1423.CrossRefGoogle ScholarPubMed
Zingg, W, Cartier, V, Inan, C, et al. Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection. PloS One 2014;9:e93898.CrossRefGoogle ScholarPubMed
Barsuk, JH, Cohen, ER, Nguyen, D, et al. Attending physician adherence to a 29-component central venous catheter bundle checklist during simulated procedures. Crit Care Med 2016;44:1871–1881.CrossRefGoogle ScholarPubMed
Gonzales, M, Rocher, I, Fortin, E, et al. A survey of preventive measures used and their impact on central line-associated bloodstream infections (CLABSIs) in intensive care units (SPIN-BACC). BMC Infect Dis 2013;13:562.CrossRefGoogle Scholar
Piazza, AJ, Brozanski, B, Provost, L, et al. SLUG bug: quality improvement with orchestrated testing leads to NICU CLABSI reduction. Pediatrics 2016;137(1). doi: 10.1542/peds.2014-3642.CrossRefGoogle Scholar
Wu, SY, Ling, Q, Cao, LH, Wang, J, Xu, MX, Zeng, WA. Real-time two-dimensional ultrasound guidance for central venous cannulation: a meta-analysis. Anesthesiology 2013;118:361–375.CrossRefGoogle ScholarPubMed
Lau, CS, Chamberlain, RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res 2016;80:178–184.CrossRefGoogle ScholarPubMed
Rupp, SM, Apfelbaum, JL, Blitt, C, et al. Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access. Anesthesiology 2012;116:539–573.Google ScholarPubMed
Mimoz, O, Lucet, JC, Kerforne, T, et al. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet 2015;386:2069–2077.CrossRefGoogle ScholarPubMed
O’Grady, NP, Alexander, M, Burns, LA, et al. Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e162–e193.CrossRefGoogle ScholarPubMed
Loveday, HP, Wilson, JA, Pratt, RJ, et al. epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014;86 Suppl 1:S1–S70.CrossRefGoogle Scholar
Prevention of hospital-acquired sepsis in intensive care unit (except cross transmission and neonate). Ann Fr Anesth Reanim 2009;10:912–920.Google Scholar
Casey, A, Itrakjy, A, Birkett, C, et al. A comparison of the efficacy of 70% v/v isopropyl alcohol with either 0.5% w/v or 2% w/v chlorhexidine gluconate for skin preparation before harvest of the long saphenous vein used in coronary artery bypass grafting. Am J Infect 2015;43:816–820.Google ScholarPubMed
Adams, D, Quayum, M, Worthington, T, Lambert, P, Elliott, T. Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant. J Hosp Infect 2005;61:287–290.CrossRefGoogle ScholarPubMed