1887
  1. Home
  2. Eurosurveillance
  3. Volume 28, Issue 25, 22/Jun/2023
  4. Article
Surveillance Open Access
Like 0
Download

Abstract

Background

Central line-associated bloodstream infection (CLABSI) is among the most common preventable infectious complications in patients in intensive care units (ICU). In 2011, the Israel National Center for Infection Control initiated a nationwide CLABSI prevention programme.

Aim

To evaluate the impact of different components of the programme on CLABSI and non-CLABSI rates in medical-surgical ICUs.

Methods

We included data collected from all 29 medical-surgical ICUs in Israel from November 2011 to December 2019. The study period was divided into three phases: I (baseline, initial CLABSI prevention guidelines introduced, initial feedback on rates provided), II (initial guidelines widely implemented, surveillance undertaken, feedback continued) and III (after implementation of additional prevention measures). Interrupted time series analysis was used to compare CLABSI and non-CLABSI rates during the three phases.

Results

The pooled mean (SD) incidence of CLABSI per 1,000 central line-days dropped from 7.4 (0.38) in phase I to 2.1 (0.13) in phase III (p < 0.001). The incidence rate ratio (IRR) was 0.63 (95% CI: 0.51–0.79) between phases I and II, and 0.78 (95% CI: 0.59–1.02) between phases II and III. The pooled mean (SD) incidence of non-CLABSI per 1,000 patient-days declined from 5.3 (0.24) in phase I to 3.4 (0.13) in phase III (p < 0.001).

Conclusion

National CLABSI prevention guidelines, surveillance and feedback resulted in significant reductions in CLABSI and non-CLABSI rates. In the wake of further interventions, significant reduction was achieved in ICUs reporting improvement in the uptake of additional prevention measures.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.25.2200688
2023-06-22
2024-11-21
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.25.2200688
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/25/eurosurv-28-25-2.html?itemId=/content/10.2807/1560-7917.ES.2023.28.25.2200688&mimeType=html&fmt=ahah

References

  1. Garrouste-Orgeas M, Timsit JF, Tafflet M, Misset B, Zahar JR, Soufir L, et al. Excess risk of death from intensive care unit-acquired nosocomial bloodstream infections: a reappraisal. Clin Infect Dis. 2006;42(8):1118-26.  https://doi.org/10.1086/500318  PMID: 16575729 
  2. Prowle JR, Echeverri JE, Ligabo EV, Sherry N, Taori GC, Crozier TM, et al. Acquired bloodstream infection in the intensive care unit: incidence and attributable mortality. Crit Care. 2011;15(2):R100.  https://doi.org/10.1186/cc10114  PMID: 21418635 
  3. Barnett AG, Page K, Campbell M, Martin E, Rashleigh-Rolls R, Halton K, et al. The increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections: a case-control study. BMJ Open. 2013;3(10):e003587.  https://doi.org/10.1136/bmjopen-2013-003587  PMID: 24176795 
  4. World Health Organization (WHO). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2022. Geneva: WHO; 2022. Available from: https://www.who.int/publications/i/item/9789240062702
  5. Schechner V, Wulffhart L, Temkin E, Feldman SF, Nutman A, Shitrit P, et al. One-year mortality and years of potential life lost following bloodstream infection among adults: A nation-wide population based study. Lancet Reg Health Eur. 2022;23:100511.  https://doi.org/10.1016/j.lanepe.2022.100511  PMID: 36158527 
  6. Centers for Disease Control and Prevention (CDC). Bloodstream infection event (central line-associated bloodstream infection and non-central line associated bloodstream infection). Atlanta: CDC; 2019. Available from: https://www.cdc.gov/nhsn/pdfs/validation/2019/pcsmanual_2019-508.pdf.
  7. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals 2011-2012. Available from: https://www.ecdc.europa.eu/en/publications-data/point-prevalence-survey-healthcare-associated-infections-and-antimicrobial-use-0
  8. Culshaw N, Glover G, Whiteley C, Rowland K, Wyncoll D, Jones A, et al. Healthcare-associated bloodstream infections in critically ill patients: descriptive cross-sectional database study evaluating concordance with clinical site isolates. Ann Intensive Care. 2014;4(1):34.  https://doi.org/10.1186/s13613-014-0034-8  PMID: 25593750 
  9. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725-32.  https://doi.org/10.1056/NEJMoa061115  PMID: 17192537 
  10. Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC, Boersma E, et al. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16(6):724-34.  https://doi.org/10.1016/S1473-3099(15)00409-0  PMID: 26907734 
  11. Ben-David D, Vaturi A, Solter E, Temkin E, Carmeli Y, Schwaber MJ, Israel CLABSI Prevention Working Group. The association between implementation of second-tier prevention practices and CLABSI incidence: A national survey. Infect Control Hosp Epidemiol. 2019;40(10):1094-9.  https://doi.org/10.1017/ice.2019.190  PMID: 31339089 
  12. Hughes JM. Study on the efficacy of nosocomial infection control (SENIC Project): results and implications for the future. Chemotherapy. 1988;34(6):553-61.  https://doi.org/10.1159/000238624  PMID: 3243099 
  13. Centers for Disease Control and Prevention (CDC). Data summary of HAIs in the US: assessing progress 2006- 2016. Atlanta: CDC; 2017. Available from: https://www.cdc.gov/hai/data/archive/data-summary-assessing-progress.html
  14. Hansen S, Schwab F, Schneider S, Sohr D, Gastmeier P, Geffers C. Time-series analysis to observe the impact of a centrally organized educational intervention on the prevention of central-line-associated bloodstream infections in 32 German intensive care units. J Hosp Infect. 2014;87(4):220-6.  https://doi.org/10.1016/j.jhin.2014.04.010  PMID: 24973015 
  15. Canadian Nosocomial Infection Surveillance Program1*. Device-associated infections in Canadian acute-care hospitals from 2009 to 2018. Can Commun Dis Rep. 2020;46(1112):387-97.  https://doi.org/10.14745/ccdr.v46i1112a05  PMID: 33447160 
  16. Kim EJ, Kang SY, Kwak YG, Kim SR, Shin MJ, Yoo HM, et al. Ten-year surveillance of central line-associated bloodstream infections in South Korea: Surveillance not enough, action needed. Am J Infect Control. 2020;48(3):285-9.  https://doi.org/10.1016/j.ajic.2019.07.020  PMID: 31493935 
  17. Vaughn VM, Saint S, Krein SL, Forman JH, Meddings J, Ameling J, et al. Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies. BMJ Qual Saf. 2019;28(1):74-84.  https://doi.org/10.1136/bmjqs-2017-007573  PMID: 30045864 
  18. Rosenthal VD, Duszynska W, Ider BE, Gurskis V, Al-Ruzzieh MA, Myatra SN, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2013-2018, Adult and Pediatric Units, Device-associated Module. Am J Infect Control. 2021;49(10):1267-74.  https://doi.org/10.1016/j.ajic.2021.04.077  PMID: 33901588 
  19. Valencia C, Hammami N, Agodi A, Lepape A, Herrejon EP, Blot S, et al. Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): results of a worldwide survey. Antimicrob Resist Infect Control. 2016;5(1):49.  https://doi.org/10.1186/s13756-016-0139-y  PMID: 27895904 
  20. Kang M, Nagaraj MB, Campbell KK, Nazareno IA, Scott DJ, Arocha D, et al. The role of simulation-based training in healthcare-associated infection (HAI) prevention. Antimicrob Steward Healthc Epidemiol. 2022;2(1):e20.  https://doi.org/10.1017/ash.2021.257  PMID: 36310779 
  21. Lai CC, Cia CT, Chiang HT, Kung YC, Shi ZY, Chuang YC, et al. Implementation of a national bundle care program to reduce central line-associated bloodstream infections in intensive care units in Taiwan. J Microbiol Immunol Infect. 2018;51(5):666-71.  https://doi.org/10.1016/j.jmii.2017.10.001  PMID: 29108783 
  22. Talbot TR, Bratzler DW, Carrico RM, Diekema DJ, Hayden MK, Huang SS, et al. Public reporting of health care-associated surveillance data: recommendations from the healthcare infection control practices advisory committee. Ann Intern Med. 2013;159(9):631-5.  https://doi.org/10.7326/0003-4819-159-9-201311050-00011  PMID: 24189597 
  23. Mayer J, Greene T, Howell J, Ying J, Rubin MA, Trick WE, et al. Agreement in classifying bloodstream infections among multiple reviewers conducting surveillance. Clin Infect Dis. 2012;55(3):364-70.  https://doi.org/10.1093/cid/cis410  PMID: 22539665 
  24. Larsen EN, Gavin N, Marsh N, Rickard CM, Runnegar N, Webster J. A systematic review of central-line-associated bloodstream infection (CLABSI) diagnostic reliability and error. Infect Control Hosp Epidemiol. 2019;40(10):1100-6.  https://doi.org/10.1017/ice.2019.205  PMID: 31362804 
  25. Schwaber MJ, Carmeli Y. An ongoing national intervention to contain the spread of carbapenem-resistant enterobacteriaceae. Clin Infect Dis. 2014;58(5):697-703.  https://doi.org/10.1093/cid/cit795  PMID: 24304707 
  26. Marcos M, Soriano A, Iñurrieta A, Martínez JA, Romero A, Cobos N, et al. Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens. J Antimicrob Chemother. 2011;66(9):2119-25.  https://doi.org/10.1093/jac/dkr231  PMID: 21665905 
  27. Novosad SA, Fike L, Dudeck MA, Allen-Bridson K, Edwards JR, Edens C, et al. Pathogens causing central-line-associated bloodstream infections in acute-care hospitals-United States, 2011-2017. Infect Control Hosp Epidemiol. 2020;41(3):313-9.  https://doi.org/10.1017/ice.2019.303  PMID: 31915083 
  28. Kadri S, Hohmann S, Zhang F, O’Grady N, Klompas M. Klompas. Impact of penalties for central line-associated bloodstream infections on blood culture ordering. Crit Care Med. 2016;44(12) suppl 1;96.  https://doi.org/10.1097/01.ccm.0000508742.53029.ca 
  29. Eggimann P, Pagani JL, Dupuis-Lozeron E, Ms BE, Thévenin MJ, Joseph C, et al. Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years. Intensive Care Med. 2019;45(6):823-33.  https://doi.org/10.1007/s00134-019-05617-x  PMID: 30997542 
Impact of intensified prevention measures on rates of hospital-acquired bloodstream infection in medical-surgical intensive care units, Israel, 2011 to 2019
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Debby+Ben-David&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ben-David Debby</a>, <a href="/search?value1=Azza+Vaturi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vaturi Azza</a>, <a href="/search?value1=Liat+Wulffhart&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wulffhart Liat</a>, <a href="/search?value1=Elizabeth+Temkin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Temkin Elizabeth</a>, <a href="/search?value1=Ester+Solter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Solter Ester</a>, <a href="/search?value1=Yehuda+Carmeli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Carmeli Yehuda</a>, <a href="/search?value1=Mitchell+J+Schwaber&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schwaber Mitchell J</a>, <a href="/search?value1=the+National+HA-BSI+Prevention+Working+Group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">the National HA-BSI Prevention Working Group</a></span>. Impact of intensified prevention measures on rates of hospital-acquired bloodstream infection in medical-surgical intensive care units, Israel, 2011 to 2019. <a href="/content/ecdc">Euro Surveill.</a> 2023;28(25):pii=2200688. <a href="https://doi.org/10.2807/1560-7917.ES.2023.28.25.2200688" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2023.28.25.2200688</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 25 Aug 2022;&nbsp;&nbsp; <span class="generated">Accepted</span>: 05 Mar 2023 </span> </p>
/content/10.2807/1560-7917.ES.2023.28.25.2200688
/content/10.2807/1560-7917.ES.2023.28.25.2200688
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error