Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): results of a worldwide survey.

Cristina Valencia,Alain Lepape,Marie-Laurence Lambert,Eduardo Palencia Herrejon,Jean-Louis Vincent,Antonella Agodi,Stijn Blot,Naïma Hammami

doi:10.1186/s13756-016-0139-y

Abstract

BackgroundCentral line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable. We documented attitudes and practices in intensive care units (ICUs) in 2015 in order to assess compliance with CLABSI prevention guidelines.MethodsBetween June and October 2015, an online questionnaire was made available to medical doctors and nurses working in ICUs worldwide. We investigated practices related to central line (CL) insertion, maintenance and measurement of CLABSI-related data following the SHEA guidelines as a standard. We computed weighted estimates for high, middle and low-income countries using country population as a weight. Only countries providing at least 10 complete responses were included in these estimates.ResultsNinety five countries provided 3407 individual responses; no low income, 14 middle income (MIC) and 27 high income (HIC) countries provided 10 or more responses. Of the total respondents, 80% (MIC, SE = 1.5) and 81% (HIC, SE = 1.0) reported availability of written clinical guidelines for CLABSI prevention in their ICU; 23% (MIC,SE = 1.7) and 62% (HIC,SE = 1.4) reported compliance to the following (combined) recommendations for CL insertion: hand hygiene, full barrier precaution, chlorhexidine >0.5%, no topic or systemic antimicrobial prophylaxis; 60% (MIC,SE = 2.0) and 73% (HIC,SE = 1.2) reported daily assessment for the need of a central line. Most considered CLABSI measurement key to quality improvement, however few were able to report their CLABSI rate. Heterogeneity between countries was high and country specific results are made available.ConclusionsThis study has identified areas for improvement in CLABSI prevention practices linked to CL insertion and maintenance. Priorities for intervention differ between countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-016-0139-y) contains supplementary material, which is available to authorized users.

Highlights

Central line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable
Studies have shown that elementary infection control measures may reduce the incidence of CLABSIs in low and middle income countries significantly, amounting to a reduction from 6.5 to 46.0 cases per 1000 central line (CL) days to 2.4–12.4 cases per 1000 CL days [10,11,12,13,14,15]
Weighted estimates and standard errors for 14 middle and 27 high income countries are based on 3,250 responses received from the 41 countries from which at least 10 completed replies were available

Summary

Introduction

Central line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable. Central line-associated bloodstream infections (CLABSI) occurring in intensive care units (ICUs) are a cause of increased morbidity and mortality, and are largely preventable [1,2,3]. Several studies in high income countries have shown that adequate use of CLABSI prevention measures can significantly reduce CLABSI rate [6,7,8,9]. Studies have shown that elementary infection control measures may reduce the incidence of CLABSIs in low and middle income countries significantly, amounting to a reduction from 6.5 to 46.0 cases per 1000 CL days to 2.4–12.4 cases per 1000 CL days [10,11,12,13,14,15]. CLABSI rates reported in low and middle income countries, where resources are limited, are much higher than CLABSI rates reported in high income countries [16]

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