Infection Control & Hospital Epidemiology (2018), 39, 1442–1448 doi:10.1017/ice.2018.250
Original Article
Interventions to reduce unnecessary central venous catheter use to prevent central-line–associated bloodstream infections in adults: A systematic review
Zhaoyu Xiong MD1 and Haiyan Chen Professor of Nursing2 1School of Nursing at Shanghai Jiao Tong University, Shanghai, China and 2Xinhua Hospital affiliated with Shanghai Jiao Tong University of Medical, Shanghai,
China Abstract
Objective: To identify, describe, and evaluate interventions to reduce unnecessary central venous catheter (CVC) use to prevent central-line– associated bloodstream infections (CLABSIs) in adults. Design: Systematic review. Methods: The review has been registered in PROSPERO, an international prospective register of systematic reviews. We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cumulative Index to Nursing and Allied Health (CINAHL) from inception until August 28, 2018, to collect experimental and observational studies. We included all studies that implemented interventions to reduce unnecessary CVC use, defined as interventions aimed at improving appropriateness, awareness of device presence, or prompt removal of devices. Results: In total, 1,892 unique citations were identified. Among them, 1 study (7.1%) was a randomized controlled trial, 9 studies (64.3%) were quasi-experimental studies, and 4 studies (28.6%) were cohort studies. Furthermore, 13 studies (92.9%) demonstrated a decrease in CVC use after intervention despite different reporting methods, and the reduction rate varied from 6.8% to 85%. Also, 7 studies (50.0%) that reported the incidence of CLABSI described a reduction in CLABSIs ranging from 24.4% to 100.0%. Data on secondary outcomes were limited, and results of the descriptive analysis showed 70%–84% compliance with these interventions, less catheter occlusion, shorter duration of hospitalization, and cost savings. Conclusions: Interventions to reduce unnecessary CVC use significantly decrease the rate of CLABSI. Healthcare providers should strongly consider implementing these interventions for prevention of CLABSI in adults.
(Received 14 June 2018; accepted 5 September 2018; electronically published October 11, 2018)
Central-line–associated bloodstream infections (CLABSIs) have long been among the most common forms of healthcare-associated infections (HAIs). They are associated with increased morbidity, mortality, length of stay (LOS), and healthcare costs.1–4 The estimated increased LOS for 10–19 days is US$32,000–$45,814 per CLABSI episode.3–6 The development of CLABSIs is directly related to the use of central venous catheters (CVCs), and the CLABSI rate increases with the prolonged catheter dwell time.7 However, in recent studies, CVCs were frequently retained unnecessarily because of inappropriate placement, or they were not removed promptly.8,9 Thus, interventions that reduce unnecessary CVC use may enhance the comfort and safety of patients. Notable efforts have been devoted to reducing the national
incidence of CLABSI, and recent data from Centers for Disease Control and Prevention (CDC) indicated a 50% decrease in the CLABSI rate occurred between 2008 and 2014 among national
Author for correspondence: Haiyan Chen, No. 1665 Kongjiang Road, Yangpu District, Shanghai 200092 China. E-mail:
943662529@qq.com
Cite this article: Xiong Z, et al. (2018). Interventions to reduce unnecessary central
venous catheter use to prevent central-line–associated bloodstream infections in adults: A systematic review. Infection Control & Hospital Epidemiology 2018, 39, 1442–1448. doi: 10.1017/ice.2018.250
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
acute-care hospitals,10 usually by implementing a bundle of measures. However, little attention has been given to strategies that reduce unnecessary CVC use, and no evidence-based articles have explored the effectiveness of these strategies. Thus, we performed a systematic review to identify, describe and evaluate interventions to reduce unnecessary CVCs use for preventing CLABSIs in adults.
Methods
This review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement11 and the recommendations in the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0.12 This review has been registered with PROSPERO (registration no. CRD42018086680).
Criteria for study selection
We considered experimental and observational studies with or without a control group that evaluated any intervention to reduce unnecessary CVC use. We defined CVC interventions as interventions aimed at improving appropriateness, awareness of device presence, or prompt removal of devices in adult patients (age ≥ 18 years).
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