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dc.contributor.authorWalz, J. Matthias
dc.contributor.authorEllison, Richard T. III
dc.contributor.authorMack, Deborah A.
dc.contributor.authorFlaherty, Helen M.
dc.contributor.authorMcIlwaine, John K.
dc.contributor.authorWhyte, Kathleen G.
dc.contributor.authorLandry, Karen E.
dc.contributor.authorBaker, Stephen P.
dc.contributor.authorHeard, Stephen O.
dc.date2022-08-11T08:07:58.000
dc.date.accessioned2022-08-23T15:37:36Z
dc.date.available2022-08-23T15:37:36Z
dc.date.issued2015-04-01
dc.date.submitted2016-01-05
dc.identifier.citation<p>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.</p>
dc.identifier.issn1526-7598
dc.identifier.doi10.1213/ANE.0b013e3182a8b01b
dc.identifier.pmid24149581
dc.identifier.urihttp://hdl.handle.net/20.500.14038/25752
dc.description.abstractBACKGROUND: 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.
dc.language.isoen_US
dc.publisherLippincott Williams & Wilkins
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=24149581&dopt=Abstract">Link to article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1213/ANE.0b013e3182a8b01b
dc.subjectBacteremia
dc.subjectCatheter-Related Infections
dc.subjectCatheterization, Central Venous
dc.subjectCentral Venous Catheters
dc.subjectChlorhexidine
dc.subjectCritical Care
dc.subjectCritical Illness
dc.subjectHand Hygiene
dc.subjectHumans
dc.subjectIntensive Care Units
dc.subjectInterdisciplinary Communication
dc.subjectPatient Care Team
dc.subjectRegression Analysis
dc.subjectStaphylococcal Infections
dc.subjectStaphylococcus
dc.subjectAnesthesiology
dc.subjectClinical Epidemiology
dc.subjectHealth Services Administration
dc.subjectInfectious Disease
dc.titleThe bundle "plus": the effect of a multidisciplinary team approach to eradicate central line-associated bloodstream infections
dc.typeJournal Article
dc.source.journaltitleAnesthesia and analgesia
dc.source.volume120
dc.source.issue4
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/anesthesiology_pubs/164
dc.identifier.contextkey7984015
html.description.abstract<p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p>
dc.identifier.submissionpathanesthesiology_pubs/164
dc.contributor.departmentDepartment of Quantitative Health Sciences
dc.contributor.departmentDepartment of Medicine, Division of Infectious Diseases and Immunology
dc.contributor.departmentDepartment of Anesthesiology
dc.source.pages868-76


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