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Published on: July 13, 2019
Quantitative Results of a National Intervention to Prevent Central Line-Associated Bloodstream Infection: A Pre-Post
Payal K Patel1, M Todd Greene1, Karen Jones2
1University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (P.K.P., M.T.G., S.S., V.C.).
Background:
Central line-associated bloodstream infection (CLABSI) remains prevalent in hospitals in the United States.
Objective:
To evaluate the impact of a multimodal intervention in hospitals with elevated rates of health care-associated infection.
Design:
Pre-post observational evaluation of a prospective, national, clustered, nonrandomized initiative of 3 cohorts of hospitals.
Setting:
Acute care, long-term acute care, and critical access hospitals, including intensive care units and medical/surgical wards.
Participants:
Target hospitals had a cumulative attributable difference above the first tertile of performance for Clostridioides difficile infection and another health care-associated infection (such as CLABSI). Some hospitals that did not meet these criteria also participated.
Intervention:
A multimodal intervention consisting of recommendations and tools for prioritizing and implementing evidence-based infection prevention strategies, on-demand educational videos, webinars led by content experts, and access to content experts.
Measurements:
Rates of CLABSI and device utilization ratio pre- and postintervention.
Results:
Between November 2016 and May 2018, 387 hospitals in 23 states and the District of Columbia participated. Monthly preimplementation CLABSI rates ranged from 0 to 71.4 CLABSIs per 1000 catheter-days. Over the study period, the unadjusted CLABSI rate was low and decreased from 0.88 to 0.80 CLABSI per 1000 catheter-days. Between the pre- and postintervention periods, device utilization decreased from 24.05 to 22.07 central line-days per 100 patient-days. However, a decreasing trend in device utilization was also observed during the preintervention period.
Limitations:
The intervention period was brief. Participation in and adherence to recommended interventions were not fully assessed. Rates of CLABSI were low. Patient characteristics could not be assessed.
Conclusion:
In hospitals with a disproportionate burden of health care-associated infection, a multimodal intervention did not reduce rates of CLABSI.
Primary Funding Source:
Centers for Disease Control and Prevention.
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