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Clin Infect Dis. 2014 Jul 1;59(1):96-105. doi: 10.1093/cid/ciu239. Epub 2014 Apr 9.

Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis.

Author information

  • 1Faculty of Medicine and Health Sciences, Ghent University.
  • 2Health Economics and Patient Safety, Hasselt University, Hasselt, Belgium.
  • 3Faculty of Medicine and Health Sciences, Ghent University General Internal Medicine, Ghent University Hospital, Ghent.
  • 4Faculty of Medicine and Health Sciences, Ghent University Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
  • 5Faculty of Medicine and Health Sciences, Ghent University General Internal Medicine, Ghent University Hospital, Ghent Health Economics and Patient Safety, Hasselt University, Hasselt, Belgium.

Abstract

This systematic review and meta-analysis examines the impact of quality improvement interventions on central line-associated bloodstream infections in adult intensive care units. Studies were identified through Medline and manual searches (1995-June 2012). Random-effects meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). 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, .33-.46]; P < .001). This effect was more pronounced for trials implementing a bundle or checklist approach (P = .03). Furthermore, meta-analysis of 6 interrupted time series studies revealed an infection rate reduction 3 months postintervention (OR, 0.30 [95% CI, .10-.88]; P = .03). There was no difference in infection rates between studies with low or high baseline rates (P = .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.

© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

KEYWORDS:

catheter-related bloodstream infection; central line–associated bloodstream infection; meta-analysis; quality improvement intervention

PMID:
24723276
[PubMed - indexed for MEDLINE]
PMCID:
PMC4305144
Free PMC Article
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