This systematic review and meta-analysis examines the impact of quality improvement interventions on central line-associated bloodstream infections in adult ICUs. Studies were identified through Medline and manual searches (1995-June 2012). Random-effects meta-analysis obtained pooled odds ratios (OR) and 95% confidence intervals (CI). Meta-regression assessed the impact of bundle/checklist interventions and high baseline rates on intervention effect. Forty-one before-after studies identified an infection rate decrease (OR 0.39; 95% CI 0.33-0.46; p<0.001). This effect was more pronounced for trials implementing a bundle or checklist approach (p=0.03). Furthermore, meta-analysis of six interrupted time series studies revealed an infection rate reduction three months post-intervention (OR 0.30; 95% CI 0.10-0.88; p=0.03). There was no difference in infection rates between studies with low or high baseline rates (p=0.18). These results suggest that quality improvement interventions contribute to the prevention of central line-associated bloodstream infections. Implementation of care bundles and checklists appears to yield stronger risk reductions.
Blot, K., Bergs, J., Vogelaers, D., Blot, S. and Vandijck, D. (2014) Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clinical Infectious Diseases. April 9th. (epub ahead of print).