The bundle "plus": the effect of a multidisciplinary team approach to eradicate central line-associated bloodstream infections
Authors
Walz, J. MatthiasEllison, Richard T. III
Mack, Deborah A.
Flaherty, Helen M.
McIlwaine, John K.
Whyte, Kathleen G.
Landry, Karen E.
Baker, Stephen P.
Heard, Stephen O.
UMass Chan Affiliations
Department of Quantitative Health SciencesDepartment of Medicine, Division of Infectious Diseases and Immunology
Department of Anesthesiology
Document Type
Journal ArticlePublication Date
2015-04-01Keywords
BacteremiaCatheter-Related Infections
Catheterization, Central Venous
Central Venous Catheters
Chlorhexidine
Critical Care
Critical Illness
Hand Hygiene
Humans
Intensive Care Units
Interdisciplinary Communication
Patient Care Team
Regression Analysis
Staphylococcal Infections
Staphylococcus
Anesthesiology
Clinical Epidemiology
Health Services Administration
Infectious Disease
Metadata
Show full item recordAbstract
BACKGROUND: Central line-associated bloodstream infections (CLABSIs) have decreased significantly over the last decade. Further reductions in CLABSI rates should be possible. We describe a multidisciplinary approach to the reduction of CLABSIs. METHODS: This was an observational study of critically ill patients requiring central venous catheters in 8 intensive care units in a tertiary medical center. We implemented a catheter bundle that included hand hygiene, education of providers, chlorhexidine skin preparation, use of maximum barrier precautions, a dedicated line cart, checklist, avoidance of the femoral vein for catheter insertion, chlorhexidine-impregnated dressings, use of anti-infective catheters, and daily consideration of the need for the catheter. Additional measures included root cause analyses of all CLABSIs, creation of a best practice atlas for internal jugular catheters, and enhanced education on blood culture collection. Data were analyzed using the Poisson test and regression. RESULTS: CLABSI, catheter use, and microbiology were tracked from 2004 to 2012. There was a 92% reduction in CLABSIs (95% lower confidence limit: 67.4% reduction, P < 0.0001). Central venous catheter use decreased significantly from 2008 to 2012 (P = 0.032, -151 catheters per year, 95% confidence limits: -277 to -25), whereas peripherally inserted central catheter use increased (P = 0.005, 89 catheters per year, 95% confidence limits: 50 to 127). There was no apparent association between unit-specific Acute Physiology And Chronic Health Evaluation III/IV scores and CLABSI. Three units have not had a CLABSI in more than a year. The most common organism isolated was coagulase-negative staphylococcus. Since the implementation of minocycline/rifampin catheters, no cases of methicillin-resistant Staphylococcus aureus CLABSI have occurred. CONCLUSIONS: The implementation of a standard catheter bundle combined with chlorhexidine dressings, minocycline/rifampin catheters, and other behavioral changes was associated with a sustained reduction in CLABSIs.Source
Walz JM, Ellison RT 3rd, Mack DA, Flaherty HM, McIlwaine JK, Whyte KG, Landry KE, Baker SP, Heard SO; CCOC Research Group. The bundle "plus": the effect of a multidisciplinary team approach to eradicate central line-associated bloodstream infections. Anesth Analg. 2015 Apr;120(4):868-76. doi:10.1213/ANE.0b013e3182a8b01b. PubMed PMID: 24149581.
DOI
10.1213/ANE.0b013e3182a8b01bPermanent Link to this Item
http://hdl.handle.net/20.500.14038/25752PubMed ID
24149581Related Resources
Link to article in PubMedae974a485f413a2113503eed53cd6c53
10.1213/ANE.0b013e3182a8b01b