Prevention of Central Line-Associated Bloodstream Infections Through Educational Interventions in Adult Intensive Care Units: A Systematic Review.

Maria Foka,Maria Kyranou,Ekaterini Lambrinou,Theodoros Kyprianou,Eleni Nicolaou,Elizabeth Papathanassoglou,Lakis Palazis

doi:10.7759/cureus.17293

Abstract

Central line-associated bloodstream infections (CLABSIs) represent a severe systemic threat to patients admitted in ICUs and contribute to increased mortality, prolonged length of stay in ICUs, and increased costs. The majority of CLABSIs are preventable. The current systematic review aimed to investigate the effectiveness of educational methods on CLABSI rates in adult ICUs.A systematic literature search was conducted using the electronic databases of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Cochrane Database of Systematic Reviews for studies published from the beginning of 1995 to March 2020. The terms used for the search were as follows: central venous catheters, infection, central line-associated bloodstream infections, intensive care unit, and education intervention in all possible combinations and using the word ‘and’ between them. Data were extracted independently and crosschecked by two authors using a standard data collection form. The quality of the studies included in the review was assessed using the Methodological Index for Non-randomized Studies (MINORS).The current systematic review included 27 interventional studies of central line insertion or maintenance or both in adult ICU settings with documentation of the CLABSI incidence expressed per 1,000 catheter days. A large deviation between the length of time and type of educational interventions was found.Statistical significance was found in all studies (except one) in terms of CLABSI reduction despite the large variation of the length or the type of the educational intervention. Continuing education on infection prevention may be necessary to maintain the post-intervention results and improve clinical outcomes.

Highlights

BackgroundCentral venous catheters (CVCs) are the most important devices used in ICU patients, and they enable the administration of medications, fluids, and blood products directly to the central venous system as well as hemodialysis therapy and hemodynamic monitoring [1]
The current systematic review included 27 interventional studies of central line insertion or maintenance or both in adult ICU settings with documentation of the central line-associated bloodstream infections (CLABSIs) incidence expressed per 1,000 catheter days
CLABSIs are defined as bloodstream infections with an onset of at least 48 hours after the insertion of a central catheter, which is not related to another site [2]

Summary

Introduction

Central venous catheters (CVCs) are the most important devices used in ICU patients, and they enable the administration of medications, fluids, and blood products directly to the central venous system as well as hemodialysis therapy and hemodynamic monitoring [1]. They are extremely necessary tools, CVCs can expose critically ill patients to the risk of central line-associated bloodstream infections (CLABSIs). The International Nosocomial Infection Control Consortium (INICC) has stated that the pooled incidence of CLABSIs in INICC ICUs (ie, in Africa, Asia, Europe, and Latin America) is 4.9 infections per 1,000 central-line days, and it is nearly five times higher than those reported in the USA [11]

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