Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection.

Walter Zingg,François Clergue,Vanessa Cartier,Cigdem Inan,Bernhard Walder,Angèle Gayet-Ageron,Sylvie Touveneau,Michel Theriault,Didier Pittet

doi:10.1371/journal.pone.0093898

Walter Zingg, François Clergue + Show 7 more

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https://doi.org/10.1371/journal.pone.0093898

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Journal: PloS one	Publication Date: Apr 8, 2014
Citations: 104	License type: CC BY 4.0

Affiliation: University of Geneva

Abstract

Central line-associated bloodstream infection (CLABSI) is the major complication of central venous catheters (CVC). The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88–0.96]; P<0.001) after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days) in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22). Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI.

Highlights

Central vascular lines are indispensable in hospital care, but the major potential complication of their use is central line-associated bloodstream infection (CLABSI) [1,2]
Most studies and interventions for the prevention of central venous catheter (CVC) infection are performed in intensive care units (ICU)
Many studies conducted in the ICU have shown that bundle strategies or multimodal intervention programmes reduced CLABSI rates by emphasizing best practice for catheter insertion and care [7,8,9,10,11,12,13,14]

Summary

Introduction

Central vascular lines are indispensable in hospital care, but the major potential complication of their use is central line-associated bloodstream infection (CLABSI) [1,2]. Most studies and interventions for the prevention of central venous catheter (CVC) infection are performed in intensive care units (ICU). The incidence of CLABSI is reported to be even higher in some non-ICU settings in the rare studies where surveillance included all hospital wards [4,5,6], stressing the need for hospital-wide surveillance and prevention activities. Many studies conducted in the ICU have shown that bundle strategies or multimodal intervention programmes reduced CLABSI rates by emphasizing best practice for catheter insertion and care [7,8,9,10,11,12,13,14]. The current study evaluated the effectiveness of a hospital-wide, multimodal, prevention strategy on the reduction of CLABSI reduction

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