Compliance With Central Line Maintenance Bundle and Infection Rates

Area of Science:

• Healthcare Quality Improvement
• Infection Prevention and Control
• Patient Safety

Background:

• Central line-associated bloodstream infections (CLABSI) are a significant concern in healthcare settings.
• While bundle compliance is considered key for CLABSI prevention, its direct relationship with outcomes requires further investigation.
• Understanding factors influencing this relationship is crucial for optimizing infection control strategies.

Purpose of the Study:

• To determine the correlation between reported bundle compliance and CLABSI rates within the Solutions for Patient Safety network.
• To identify hospital and process-related factors that may influence the association between bundle compliance and CLABSI rates.

Main Methods:

• Analysis of monthly CLABSI rates and bundle compliance data from 159 hospitals over a defined period.
• Network-level correlation analysis, adjusting for temporal trends.
• Negative binomial regression to assess the impact of hospital type, central line audit frequency, and safety culture program adoption.

Main Results:

• A statistically significant negative correlation was observed between monthly bundle reliability and monthly CLABSI rates (-0.35, P <.001).
• After adjusting for temporal trends, the partial correlation remained significant (-0.25, P = .004).
• Hospital type was a significant moderator; hospitals within hospitals demonstrated a significant association between ≥95% compliance and lower CLABSI rates, unlike freestanding children's hospitals.

Conclusions:

• Adherence to best practice bundles is associated with reduced CLABSI rates.
• Hospital-level characteristics, specifically the 'hospital within hospital' model, influence the effectiveness of bundle compliance in reducing CLABSI.
• Process-related factors like audit rates and safety culture training did not significantly impact this association.