Hostname: page-component-6b989bf9dc-g5k2d Total loading time: 0 Render date: 2024-04-14T13:46:57.277Z Has data issue: false hasContentIssue false
  • English
  • Français

Interventions to reduce unnecessary central venous catheter use to prevent central-line–associated bloodstream infections in adults: A systematic review

Published online by Cambridge University Press:  11 October 2018

Zhaoyu Xiong  and
Haiyan Chen
Zhaoyu Xiong
Affiliation:
School of Nursing at Shanghai Jiao Tong University, Shanghai, China
Haiyan Chen*
Affiliation:
Xinhua Hospital affiliated with Shanghai Jiao Tong University of Medical, Shanghai, China
*
Author for correspondence: Haiyan Chen, No. 1665 Kongjiang Road, Yangpu District, Shanghai 200092 China. E-mail: 943662529@qq.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To identify, describe, and evaluate interventions to reduce unnecessary central venous catheter (CVC) use to prevent central-line–associated bloodstream infections (CLABSIs) in adults.

Design

Systematic review.

Methods

The review has been registered in PROSPERO, an international prospective register of systematic reviews. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cumulative Index to Nursing and Allied Health (CINAHL) from inception until August 28, 2018, to collect experimental and observational studies. We included all studies that implemented interventions to reduce unnecessary CVC use, defined as interventions aimed at improving appropriateness, awareness of device presence, or prompt removal of devices.

Results

In total, 1,892 unique citations were identified. Among them, 1 study (7.1%) was a randomized controlled trial, 9 studies (64.3%) were quasi-experimental studies, and 4 studies (28.6%) were cohort studies. Furthermore, 13 studies (92.9%) demonstrated a decrease in CVC use after intervention despite different reporting methods, and the reduction rate varied from 6.8% to 85%. Also, 7 studies (50.0%) that reported the incidence of CLABSI described a reduction in CLABSIs ranging from 24.4% to 100.0%. Data on secondary outcomes were limited, and results of the descriptive analysis showed 70%–84% compliance with these interventions, less catheter occlusion, shorter duration of hospitalization, and cost savings.

Conclusions

Interventions to reduce unnecessary CVC use significantly decrease the rate of CLABSI. Healthcare providers should strongly consider implementing these interventions for prevention of CLABSI in adults.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 12 , December 2018 , pp. 1442 - 1448
Copyright
© 2018 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

Cite this article: Xiong Z, et al. (2018). Interventions to reduce unnecessary central venous catheter use to prevent central-line–associated bloodstream infections in adults: A systematic review. Infection Control & Hospital Epidemiology 2018, 39, 1442–1448. doi: 10.1017/ice.2018.250

References

1. Iordanou, S , Middleton, N , Papathanassoglou, E , Raftopoulos, V . Surveillance of device associated infections and mortality in a major intensive care unit in the Republic of Cyprus. BMC Infect Dis 2017;17:607.Google Scholar
2. Mishra, SB , Misra, R , Azim, A , et al. Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India. Int J Qual Health Care 2017;29:63–67.Google Scholar
3. Kaye, KS , Marchaim, D , Chen, TY , et al. Effect of nosocomial bloodstream infections on mortality, length of stay, and hospital costs in older adults. J Am Geriatr Soc 2014;62:306–311.Google Scholar
4. Goudie, A , Dynan, L , Brady, PW , Rettiganti, M . Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014;133:e1525–e1532.Google Scholar
5. Stevens, V , Geiger, K , Concannon, C , Nelson, RE , Brown, J , Dumyati, G . Inpatient costs, mortality and 30-day re-admission in patients with central-line–associated bloodstream infections. Clin Microbiol Infect 2014;20:O318–O324.Google Scholar
6. Zimlichman, E , Henderson, D , Tamir, O , et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.Google Scholar
7. Callister, D , Limchaiyawat, P , Eells, SJ , Miller, LG . Risk factors for central-line–associated bloodstream infections in the era of prevention bundles. Infect Control Hosp Epidemiol 2015;36:214–216.Google Scholar
8. Burdeu, G , Currey, J , Pilcher, D . Idle central venous catheter days pose infection risk for patients after discharge from intensive care. Am J Infect Control 2014;42:453–455.Google Scholar
9. Tejedor, SC , Tong, D , Stein, J , et al. Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the “idle central venous catheter.” Infect Control Hosp Epidemiol 2012;33:50–57.Google Scholar
10. Healthcare-associated infections (HAI) progress report. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/surveillance/progress-report/index.html. Published 2016. Accessed April 10, 2018.Google Scholar
11. Moher, D , Liberati, A , Tetzlaff, J , Altman, DG . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264–269, w264.Google Scholar
12. Higgins, J , Green, S . Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0. The Cochrane Library website. http://handbook-5-1.cochrane.org/. Published 2011. Accessed Janurary 5, 2018.Google Scholar
13. Tufanaru, C , Munn, Z , Aromataris, E , Campbell, J , Hopp, L . Chapter 3: Systematic reviews of effectiveness. The Joanna Briggs Institute website. https://reviewersmanual.joannabriggs.org/. Published 2017. Accessed February 6, 2018.Google Scholar
14. Wells, G , Shea, B , O’Connell, D , et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Ottawa Hospital Research Institute website. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Published 1999. Accessed February 7, 2018.Google Scholar
15. Arora, N , Patel, K , Engell, CA , LaRosa, JA . The effect of interdisciplinary team rounds on urinary catheter and central venous catheter days and rates of infection. Am J Med Qual 2014;29:329–334.Google Scholar
16. Chandramohan, S , Navalkele, B , Mushtaq, A , Krishna, A , Kacir, J , Chopra, T . Impact of a multidisciplinary infection prevention initiative on central line and urinary catheter utilization in a long-term acute care hospital. Open Forum Infect Dis 2018;5:ofy156.Google Scholar
17. Deutsch, GB , Anantha Sathyanarayana, S , Singh, N , Nicastro, JM . Ultrasound-guided placement of midline catheters in the surgical intensive care unit: a cost-effective proposal for timely central line removal. J Surg Res 2013;191:1–5.Google Scholar
18. Morata, L , Ogilvie, C , Yon, J , Johnson, A . Decreasing peripherally inserted central catheter use with ultrasound-guided peripheral intravenous lines: a quality improvement project in the acute care setting. J Nurs Adm 2017;47:338–344.Google Scholar
19. Reeves, T , Altmiller, G , Morrison, D . A nurse-led ultrasound-enhanced vascular access preservation program: a quality improvement initiative combines advanced technology and patient-centered care. Am J Nurs 2017;117:56–64.Google Scholar
20. Swaminathan, L , Flanders, S , Rogers, M , et al. Improving PICC use and outcomes in hospitalised patients: an interrupted time series study using MAGIC criteria. BMJ Qual Saf 2018;27:271–278.Google Scholar
21. Weeks, KR , Hsu, YJ , Yang, T , Sawyer, M , Marsteller, JA . Influence of a multifaceted intervention on central line days in intensive care units: results of a national multisite study. Am J Infect Control 2014;42:S197–S202.Google Scholar
22. Au, AK , Rotte, MJ , Grzybowski, RJ , Ku, BS , Fields, JM . Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters. Am J Emerg Med 2012;30:1950–1954.Google Scholar
23. Galen, BT , Southern, WN . Ultrasound-guided peripheral intravenous catheters to reduce central venous catheter use on the inpatient medical ward. Qual Manag Health Care 2018;27:30–32.Google Scholar
24. Mccarthy, M , Al, TK . Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients. Ann Emerg Med 2013;61:198–203.Google Scholar
25. Grady, D . A Simple Approach to reducing inappropriate use of central venous catheters. JAMA Intern Med 2015;175:1234.Google Scholar
26. Ilan, R , Doan, J , Cload, B , Squires, M , Day, A . Removing nonessential central venous catheters: evaluation of a quality improvement intervention. Can J Anaesth 2012;59:1102–1110.Google Scholar
27. Seguin, P , Laviolle, B , Isslame, S , Coue, A , Malledant, Y . Effectiveness of simple daily sensitization of physicians to the duration of central venous and urinary tract catheterization. Intensive Care Med 2010;36:1202–1206.Google Scholar
28. Rattanaumpawan, P , Teeratorn, N , Thamlikitkul, V . A Cluster-randomized controlled trial of the catheter reminder and evaluation program. Infect Control Hosp Epidemiol 2016;37:231–233.Google Scholar
29. Chopra, V , Govindan, S , Kuhn, L , et al. Do clinicians know which of their patients have central venous catheters? A multicenter observational study. Ann Intern Med 2014;161:562–567.Google Scholar
30. Chopra, V , Kuhn, L , Ratz, D , Flanders, SA , Krein, SL . Vascular nursing experience, practice knowledge, and beliefs: results from the Michigan PICC1 survey. J Hosp Med 2016;11:269–275.Google Scholar
31. Climo, M , Diekema, D , Warren, DK , et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003;24:942–945.Google Scholar
32. Becerra, MB , Shirley, D , Safdar, N . Prevalence, risk factors, and outcomes of idle intravenous catheters: an integrative review. Am J Infect Control 2016;44:e167–e172.Google Scholar
33. Trick, WE , Vernon, MO , Welbel, SF , Wisniewski, MF , Jernigan, JA , Weinstein, RA . Unnecessary use of central venous catheters: the need to look outside the intensive care unit. Infect Control Hosp Epidemiol 2004;25:266–268.Google Scholar
34. Kara, A , Johnson, CS , Murray, M , Dillon, J , Hui, SL . Can the identification of an idle line facilitate its removal? A comparison between a proposed guideline and clinical practice. J Hosp Med 2016;11:489–493.Google Scholar
35. Lee, KH , Cho, NH , Jeong, SJ , Kim, MN , Han, SH , Song, YG . Effect of central-line bundle compliance on central line-associated bloodstream infections. Yonsei Med J 2018;59:376.Google Scholar
36. Liang, HW , Lin, HL . Compliance with central-line insertion bundles in an intensive care unit. Am J Infect Control 2014;42:581–582.Google Scholar
37. Leung, PO , Lin, HL , Lai, CC . Different compliance with central-line insertion bundle between intensivist and nonintensivist staff in intensive care units. Infect Control Hosp Epidemiol 2014;35:601–603.Google Scholar
38. Osorio, J , Álvarez, D , Pacheco, R , Gómez, CA , Lozano, A . Implementation of an insertion bundle for preventing central-line–associated bloodstream infections in an intensive care unit in Colombia. Rev Chilena Infect 2013;30:465–473.Google Scholar
39. Meddings, J , Rogers, MA , Krein, SL , Fakih, MG , Olmsted, RN , Saint, S . Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014;23:277–289.Google Scholar
40. Liu, YT , Alsaawi, A , Bjornsson, HM . Ultrasound-guided peripheral venous access: a systematic review of randomized-controlled trials. Eur J Emerg Med 2014;21:18–23.Google Scholar
Supplementary material: File

Xiong and Chen supplementary material

Xiong and Chen supplementary material 1

Download Xiong and Chen supplementary material(File)
File 31.3 KB