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. 2020 May;29(5):418-429.
doi: 10.1136/bmjqs-2019-009330. Epub 2020 Jan 6.

Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates

Jennifer Meddings  1   2   3   4 , M Todd Greene  5   2   3 , David Ratz  5   3 , Jessica Ameling  2   3 , Karen E Fowler  5   3 , Andrew J Rolle  6 , Louella Hung  6 , Sue Collier  6 , Sanjay Saint  5   2   3
Affiliations

Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates

Jennifer Meddings et al. BMJ Qual Saf. 2020 May.

Abstract

Background: Preventing central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) remains challenging in intensive care units (ICUs).

Objective: The Agency for Healthcare Research and Quality Safety Program for ICUs aimed to reduce CLABSI and CAUTI in units with elevated rates.

Methods: Invited hospitals had at least one adult ICU with elevated CLABSI or CAUTI rates, defined by a positive cumulative attributable difference metric (CAD >0) in the Centers for Disease Control and Prevention's Targeted Assessment for Prevention strategy. This externally facilitated programme implemented by a national project team and state hospital associations included on-demand video modules and live webinars reviewing a two-tiered approach for implementing key technical and socioadaptive factors to prevent catheter infections, using principles and tools based on the Comprehensive Unit-based Safety Program. CLABSI, CAUTI and catheter use data were collected (preintervention 13 months, intervention 12 months). Multilevel negative binomial models assessed changes in catheter-associated infection rates and catheter use.

Results: Of 366 recruited ICUs from 220 hospitals in 16 states and Puerto Rico for two cohorts, 280 ICUs completed the programme including infection outcome reporting; 274 ICUs had complete outcome data for analyses. Statistically significant reductions in adjusted infection rates were not observed (CLABSI incidence rate ratio (IRR)=0.75, 95% CI 0.52 to 1.08, p=0.13; CAUTI IRR=0.79, 95% CI 0.59 to 1.06, p=0.12). Adjusted central line utilisation (IRR=0.97, 95% CI 0.93 to 1.00, p=0.09) and adjusted urinary catheter utilisation were unchanged (IRR=0.98, 95% CI 0.95 to 1.01, p=0.14).

Conclusion: This multistate programme targeted ICUs with elevated catheter infection rates, but yielded no statistically significant reduction in CLABSI, CAUTI or catheter utilisation in the first two of six planned cohorts. Improvements in the interventions based on lessons learnt from these initial cohorts are being applied to subsequent cohorts.

Keywords: healthcare quality improvement; infection control; nosocomial infections; patient safety; quality improvement.

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Conflict of interest statement

Competing interests: JM has reported receiving honoraria for lectures and teaching related to prevention and value-based policies involving catheter-associated urinary tract infection and hospital-acquired pressure ulcers. SS has reported receiving honoraria for lectures and teaching related to prevention of catheter-associated urinary tract infection, and is on the medical advisory boards of Doximity and Jvion. JM and SS hold a provisional US patent on a technology to improve aseptic placement of urinary catheters, which was not part of this study.

Figures

Figure 1
Figure 1
External facilitation and implementation model. AHRQ, Agency for Healthcare Research and Quality; ICU, intensive care unit.*Note: AHRQ provided contract funding, set program objectives and deliverables, provided guidance throughout the project, and coordinated with other federal agencies. AHRQ was not directly responsible for the implementation of the project.
Figure 2
Figure 2
Central line-associated bloodstream infection (CLABSI) rates and central line utilisation rates, as reported to the National Healthcare Safety Network.
Figure 3
Figure 3
Catheter-associated urinary tract infection (CAUTI) rates and urinary catheter utilisation rate, as reported to the National Healthcare Safety Network.
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