Targeting prolonged short-term central venous catheters to reduce hospital-wide catheter days and CLABSI rates

IF 3.8 3区医学 Q2 INFECTIOUS DISEASES

American journal of infection control Pub Date : 2024-10-19 DOI:10.1016/j.ajic.2024.10.011

Regev Cohen MD , Shelly Lipman-Arens MD , Lamis Mahamid MD , Linor Ishay MD , Olga Feld Simon MD , Sharon Reisfeld MD , Orna Ben-Natan PhD, RN , Aliza Vaknin MN, RN , Mohammed Ganayem MA, RN , Razi Abu Hadba BA, RN , Erez Karisi MBA , Noa Melnik BSc , Sarit Freimann PhD , Maanit Shapira PhD , Nina Avshovich MD , Ayed Darawshe MA, RN , Ronit Rachmilevitch MD , Valery Istomin MD , Rena Abilevitch MA, RN , Saif Abu-Mouch MD , Elias Tannous MSc

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引用次数: 0

Abstract

Background

The risk of central line-associated bloodstream infection (CLABSI) is associated with central venous catheter (CVC) dwelling time. We implemented a hospital-wide intervention aimed to alert physicians to CVC duration and necessity and to improve the monitoring of CLABSI prevention process measures outside the intensive care unit (ICU).

Methods

A retrospective, before-after study that evaluated short-term, nonhemodialysis CVCs in and out of the ICU. The intervention included enhanced bundle-prevention measures monitoring and staff “sensitization” regarding prolonged (> 7 days) CVCs (pCVCs). The ICU intervention also included daily CVC-stewardship visits. We assessed CVC utilizations and CLABSI episodes 20 months before to 19 months after the intervention using Mann-Whitney tests.

Results

Out of the ICU, CVC-utilization ratio (CVC-UR) and pCVC-UR reduced significantly (4.1-2.7/100 hospital days, P = .005; and 28%-21%, P = .02, respectively). Bundle-prevention measures improved, and CLABSI rates reduced postintervention (7.9-3.6/1,000 CVC days, P = .03). In the ICU, pCVC-UR reduced significantly (29%-15%, P < .0001). Baseline ICU-CLABSI rates were low and did not reduce postintervention.

Conclusions

Sensitizing physicians to the existence and duration of CVCs accompanied by improved bundle-prevention measures, resulted in reduction of pCVCs, and outside the ICU, also in reduction of CVC-UR and CLABSI rates.

查看原文本刊更多论文

针对长期短期中心静脉导管，减少全院导管使用天数和 CLABSI 感染率。

背景：中心静脉导管相关血流感染（CLABSI）的风险与中心静脉导管（CVC）的留置时间有关。我们在全院范围内实施了一项干预措施，旨在提醒医生注意 CVC 的持续时间和必要性，并改善重症监护室（ICU）外对 CLABSI 预防流程措施的监控：一项回顾性、前后对比研究，评估了重症监护室内外的短期非血液透析CVC。干预措施包括加强捆绑式预防措施的监测和工作人员对长期（>7 天）CVC（pCVC）的 "敏感性"。重症监护室的干预措施还包括每日CVC巡视。我们使用 Mann-Whitney 检验法评估了干预前 20 个月至干预后 19 个月的 CVC 使用情况和 CLABSI 发病情况：在重症监护室外，CVC-使用率（CVC-UR）和pCVC-UR显著降低（分别从4.1降至2.7/100 HD，p=0.005；从28%降至21%，p=0.02）。干预后，捆绑预防措施有所改善，CLABSI 感染率也有所下降（每千个 CVC 日从 7.9 降至 3.6，p=0.03）。在重症监护室，pCVC-UR 显著降低（29% 降至 15%，P=0.03）：让医生意识到 CVC 的存在和持续时间，同时改进捆绑预防措施，可减少 pCVC，在重症监护室外，还可降低 CVC-UR 和 CLABSI 感染率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of infection control 医学-传染病学

CiteScore

7.40

自引率

4.10%

发文量

479

审稿时长

24 days

期刊介绍： AJIC covers key topics and issues in infection control and epidemiology. Infection control professionals, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC)