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Am J Infect Control. 2014 Jul;42(7):723-30. doi: 10.1016/j.ajic.2014.03.353. Epub 2014 May 23.

Sustained reduction of central line-associated bloodstream infections outside the intensive care unit with a multimodal intervention focusing on central line maintenance.

Author information

1
Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY; Center for Community Health, University of Rochester Medical Center, Rochester, NY. Electronic address: Ghinwa_dumyati@urmc.rochester.edu.
2
Center for Community Health, University of Rochester Medical Center, Rochester, NY.
3
Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY.
4
Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY.
5
Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY.
6
Infection Prevention, Highland Hospital, Rochester, NY; Infection Prevention, University of Rochester Medical Center, Rochester, NY.
7
Infection Prevention, Highland Hospital, Rochester, NY.
8
Department of Medicine, Infectious Disease Unit, Unity Health System, Rochester, NY.
9
Infection Prevention, Unity Health System, Rochester, NY.
10
Infection Control and Emergency Preparedness, FF Thompson Health System, Canandaigua, NY.
11
Infection Prevention, Lakeside Hospital, Brockport, NY.
12
Department of Medicine, Infectious Diseases Division, University of Rochester Medical Center, Rochester, NY; Department of Medicine, Highland Hospital, Rochester, NY.

Abstract

BACKGROUND:

Central venous catheter use is common outside the intensive care units (ICUs), but prevention in this setting is not well studied. We initiated surveillance for central line-associated bloodstream infections (CLABSIs) outside the ICU setting and studied the impact of a multimodal intervention on the incidence of CLABSIs across multiple hospitals.

METHODS:

This project was constructed as a prospective preintervention-postintervention design. The project comprised 3 phases (preintervention [baseline], intervention, and postintervention) over a 4.5-year period (2008-2012) and was implemented through a collaborative of 37 adult non-ICU wards at 6 hospitals in the Rochester, NY area. The intervention focused on engagement of nursing staff and leadership, nursing education on line care maintenance, competence evaluation, audits of line care, and regular feedback on CLABSI rates. Quarterly rates were compared over time in relation to intervention implementation.

RESULTS:

The overall CLABSI rate for all participating units decreased from 2.6/1000 line-days preintervention to 2.1/1,000 line-days during the intervention and to 1.3/1,000 line-days postintervention, a 50% reduction (95% confidence interval, .40-.59) compared with the preintervention period (P .0179).

CONCLUSION:

A multipronged approach blending both the adaptive and technical aspects of care including front line engagement, education, execution of best practices, and evaluation of both process and outcome measures may provide an effective strategy for reducing CLABSI rates outside the ICU.

KEYWORDS:

Needleless connector; Nursing education; Nursing engagement

PMID:
24856587
DOI:
10.1016/j.ajic.2014.03.353
[Indexed for MEDLINE]

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