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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream
Julian Bion1, Annette Richardson, Peter Hibbert
1University of Birmingham, N5 Queen Elizabeth Hospital, Birmingham, UK.
Background:
Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions.
Methods:
We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification.
Results:
Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely.
Conclusions:
The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care.
Insights
Central venous catheter-bloodstream infections (CVC-BSIs) significantly decreased in English intensive care units (ICUs). This study highlights the need for harmonized infection control practices to further improve patient care and reduce healthcare-associated infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Public Health
Background:
- Central venous catheter-bloodstream infections (CVC-BSIs) are a significant cause of morbidity and increased healthcare costs in intensive care units (ICUs).
- Previous research indicates that combining technical and non-technical interventions can substantially reduce CVC-BSI rates.
- Effective strategies are crucial for preventing these infections and improving patient outcomes in critical care settings.
Purpose of the Study:
- To evaluate the effectiveness of combined technical and non-technical interventions in reducing CVC-BSI rates across adult and pediatric intensive care units in England.
- To analyze infection rates using a stepped, non-randomized study design over a two-year period.
- To identify variations in infection control practices and their potential impact on CVC-BSI rates.
Main Methods:
- A two-year, four-cluster, stepped non-randomized study involving adult and pediatric ICUs in England.
- Utilized random-effects Poisson regression modeling to compare CVC-BSI rates before and after intervention implementation.
- Included data verification by a sample of participating ICUs to ensure data accuracy.
Main Results:
- A significant decrease in mean CVC-BSI rates was observed in adult ICUs, from 3.7 to 1.48 per 1000 CVC-patient days (p<0.0001).
- Paediatric ICUs showed a decrease from 5.65 to 2.89 per 1000 CVC-patient days, though this was not statistically significant (p=0.625).
- The reduction trend did not accelerate post-intervention training, CVC utilization remained stable, and pre-ICU infections declined concurrently. Significant variation in infection control practices was noted.
Conclusions:
- The observed reduction in CVC-BSI rates in English ICUs may be associated with a broader trend of improving healthcare-associated infection control.
- Opportunities exist to harmonize infection control practices across ICUs for greater consistency and effectiveness.
- Further research is needed to elucidate causal mechanisms and contextual factors influencing the impact of interventions on patient care.
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