National intervention to prevent central line-associated bloodstream infection

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In hospitals with a disproportionate burden of health care-associated infection, a multimodal intervention did not reduce rates of CLABSI” Patel et al (2019).

Abstract:

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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Reference:

Patel, P.K., Greene, M.T., Jones, K., Rolle, A.J., Ratz, D., Snyder, A., Saint, S. and Chopra, V. (2019) Quantitative Results of a National Intervention to Prevent Central Line-Associated Bloodstream Infection: A Pre-Post Observational Study. Annals of Internal Medicine. 171(7_Supplement), p.S23-S29. doi: 10.7326/M18-3533.

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