Infection Control & Hospital Epidemiology Data regarding our secondary outcomes were limited. Only 2
studies reported compliance with interventions, and these rates varied from 70% to 84%, which were comparably high, based on previously reported rates of compliance to CLABSI bundles of 53.7%–80%.35–38 Similarly, few studies have focused on non- infectious complications and hospital-related outcomes; more studies are needed to assess these outcomes. Regarding cost, 2 studies employing the USGPIVs program both reported a lower cost compared with CVC use: 2 other kinds of intervention (ie, restriction of CVCs insertion and reminders) are essentially simple and low-cost approaches. In 2014, Meddings et al39 published a narrative review to summarize interventions to reduce catheter-associated urinary tract infection (CAUTI) by reducing unnecessary urinary catheter use. Urinary catheter reminders and stop orders significantly reduced CAUTI rates in this study. To our knowledge, no evidence-based studies have assessed the efficacy of reducing CLABSI using interventions that avoid unnecessary CVC use. Our review provides the first evidence that interventions to reduce unnecessary CVC use are effective in preventing CLABSI in adults. Furthermore, these interventions appear to be con- venient, low risk, low cost, effective, and sustainable. Our study has several limitations. First and most importantly,
the included studies varied significantly in methodology. The studies varied in terms of study design; details of the interven- tions; definitions of CLABSI, CVC, and unnecessary CVC; and outcome reporting methods. Because of the substantial metho- dological differences, we did not perform a meta-analysis of the results of the studies. Second, only 1 of the included studies was a cluster RCT; the remaining 13 studies were either QESs or cohort studies. Because RCTs are more methodologically rig- orous than other study designs, factors inherent in the studies included may limit the generalizability of our review. Third, only 2 studiesmentioned compliance with these interventions. Osorio et al38 suggested that compliance with a CLABSI bundle was a protective factor against the development of CLABSI, so com- pliance may impact CLABSI rate. Fourth, we did not assess the efficacy of these interventions on noninfectious complications and health-related outcomes because the information provided was insufficient to do so. Finally, data on the insertion condi- tions of interventions implementing USGPIVs were insufficient. However, previous studies have demonstrated a significantly higher success rate, shorter time to successful cannulation, and fewer attempts for USGPIVs compared with the traditional method.40 In summary, interventions to reduce unnecessary CVC use significantly decreases the rate of CLABSIs. Healthcare providers should strongly consider implementing interventions to avoid CVC use (eg, alternatives to CVCs or restriction of CVC inser- tion) and/or to ensure prompt removal of unnecessary CVCs (eg, reminders). More RCTs with uniform definitions and outcome measures regarding CVC use and CLABSI rates are needed to comprehensively assess the effectiveness and safety of these interventions.
Financial support. No financial support was provided relevant to this article.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
Supplementary material. To view supplementary material for this article, please visit
https://doi.org/10.1017/ice.2018.250
References
1. Iordanou S, Middleton N, Papathanassoglou E, Raftopoulos V. Surveil- lance of device associated infections and mortality in a major intensive care unit in the Republic of Cyprus. BMC Infect Dis 2017;17:607.
2. Mishra SB, Misra R, Azim A, et al. Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India. Int J Qual Health Care 2017;29:63–67.
3. Kaye KS, Marchaim D, Chen TY, et al. Effect of nosocomial bloodstream infections on mortality, length of stay, and hospital costs in older adults. J Am Geriatr Soc 2014;62:306–311.
4. Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014;133:e1525–e1532.
5. Stevens V, Geiger K, Concannon C, Nelson RE, Brown J, Dumyati G. Inpatient costs, mortality and 30-day re-admission in patients with central-line–associated bloodstream infections. Clin Microbiol Infect 2014;20:O318–O324.
6. Zimlichman E, Henderson D, Tamir O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.
7. Callister D, Limchaiyawat P, Eells SJ, Miller LG. Risk factors for central- line–associated bloodstream infections in the era of prevention bundles. Infect Control Hosp Epidemiol 2015;36:214–216.
8. Burdeu G, Currey J, Pilcher D. Idle central venous catheter days pose infection risk for patients after discharge from intensive care. Am J Infect Control 2014;42:453–455.
9. Tejedor SC, Tong D, Stein J, et al. Temporary central venous catheter utilization patterns in a large tertiary care center: tracking the “idle central venous catheter.” Infect Control Hosp Epidemiol 2012;33:50–57.
10. Healthcare-associated infections (HAI) progress report. Centers for Disease Control and Prevention website.
https://www.cdc.gov/hai/surveil- lance/progress-report/
index.html. Published 2016. Accessed April 10, 2018.
11. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264–269, w264.
12. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0. The Cochrane Library website. http://hand-
book-5-1.cochrane.org/. Published 2011. Accessed Janurary 5, 2018.
13. Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Chapter 3: Systematic reviews of effectiveness. The Joanna Briggs Institute website.
https://reviewersmanual.joannabriggs.org/. Published 2017. Accessed Feb- ruary 6, 2018.
14. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Ottawa Hospital Research Institute website.
http://www.ohri.ca/programs/ clinical_epidemiology/
oxford.asp. Published 1999. Accessed February 7, 2018.
15. Arora N, Patel K, Engell CA, LaRosa JA. The effect of interdisciplinary team rounds on urinary catheter and central venous catheter days and rates of infection. Am J Med Qual 2014;29:329–334.
16. Chandramohan S, Navalkele B, Mushtaq A, Krishna A, Kacir J, Chopra T. Impact of a multidisciplinary infection prevention initiative on central line and urinary catheter utilization in a long-term acute care hospital. Open Forum Infect Dis 2018;5:ofy156.
17. Deutsch GB, Anantha Sathyanarayana S, Singh N, Nicastro JM. Ultrasound-guided placement of midline catheters in the surgical intensive care unit: a cost-effective proposal for timely central line removal. J Surg Res 2013;191:1–5.
18. Morata L, Ogilvie C, Yon J, Johnson A. Decreasing peripherally inserted central catheter use with ultrasound-guided peripheral intravenous lines: a quality improvement project in the acute care setting. J Nurs Adm 2017;47:338–344.
19. Reeves T, Altmiller G, Morrison D. A nurse-led ultrasound-enhanced vascular access preservation program: a quality improvement initiative combines advanced technology and patient-centered care. Am J Nurs 2017;117:56–64.
1447
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124
