Advertisement

The effect of an intervention bundle to prevent central venous catheter-related bloodstream infection in a national programme in the Netherlands.

  • Author Footnotes
    # These authors contributed equally to the paper.
    Tjallie I.I. van der Kooi
    Correspondence
    Corresponding author:National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Department of Epidemiology and Surveillance, A. van Leeuwenhoeklaan 9 3721 MA Bilthoven P: +31 6 13625161
    Footnotes
    # These authors contributed equally to the paper.
    Affiliations
    National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to the paper.
    Emma A. Smid
    Footnotes
    # These authors contributed equally to the paper.
    Affiliations
    Nextens, Book and Periodical Publishing, Amsterdam, the Netherlands (formerly employed by RIVM)
    Search for articles by this author
  • Mayke B.G. Koek
    Affiliations
    National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
    Search for articles by this author
  • Suzanne E. Geerlings
    Affiliations
    Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, location University of Amsterdam, Amsterdam Infection and Immunity, Amsterdam Public Health, the Netherlands
    Search for articles by this author
  • Lonneke G.M. Bode
    Affiliations
    Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
    Search for articles by this author
  • Titia E.M. Hopmans
    Affiliations
    National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
    Search for articles by this author
  • Sabine C. de Greeff
    Affiliations
    National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to the paper.
Published:November 19, 2022DOI:https://doi.org/10.1016/j.jhin.2022.11.006

      Summary

      Introduction

      Central venous catheters (CVCs) can lead to central line-related bloodstream infections (CRBSI). A six-item bundle was introduced in 2009 to prevent CRBSI in Dutch hospitals.

      Aim

      This study aimed to determine the impact of an intervention bundle on CRBSI risk.

      Methods

      Data were obtained from hospitals participating in the national CRBSI surveillance between 2009 and 2019. Bundle compliance was evaluated as a total (“overall”) bundle (all six items) and as an insertion bundle (four items) and a maintenance bundle (two daily checks). We estimated the impact of the overall and partial bundles, using multilevel Cox regression.

      Findings

      Of the 66 hospitals in the CRBSI surveillance 56 (84.8%) recorded annual bundle (non)compliance for >80% of the CVCs, for 1-9 years. In these 56 hospitals CRBSI incidence decreased from 4.0 to 1.6/1000 CVC days. In the intensive care units (ICU) compliance was not associated with CRBSI risk (hazard ratio (HR) for the overall, insertion and maintenance bundle were 1.14 [95% confidence interval 0.80-1.64], 1.05 [0.56-1.95] and 1.13 [0.79-1.62]), respectively. Outside the ICU the non-significant association of compliance with the overall bundle (HR 1.36 [0.96-1.93]) resulted from opposite effects of the insertion bundle, associated with decreased risk (HR 0.50 [0.30-0.85]) and the maintenance bundle, associated with increased risk (HR 1.68 [1.19-2.36]).

      Conclusion

      Following a national program to introduce an intervention bundle CRBSI incidence decreased significantly. In the ICU bundle compliance was not associated with CRBSI risk, but outside the ICU improved compliance to the insertion bundle resulted in a decreased CRBSI risk.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Blot S.I.
        • Depuydt P.
        • Annemans L.
        • Benoit D.
        • Hoste E.
        • De Waele J.J.
        • et al.
        Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections.
        Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2005; 41: 1591-1598https://doi.org/10.1086/497833
        • Leistner R.
        • Hirsemann E.
        • Bloch A.
        • Gastmeier P.
        • Geffers C.
        Costs and prolonged length of stay of central venous catheter-associated bloodstream infections (CVC BSI): a matched prospective cohort study.
        Infection. 2014; 42: 31-36https://doi.org/10.1007/s15010-013-0494-z
        • van der Kooi T.I.
        • Wille J.C.
        • van Benthem B.H.
        Catheter application, insertion vein and length of ICU stay prior to insertion affect the risk of catheter-related bloodstream infection.
        The Journal of hospital infection. 2012; 80: 238-244https://doi.org/10.1016/j.jhin.2011.11.012
        • van der Kooi T.I.
        • Mannien J.
        • Wille J.C.
        • van Benthem B.H.
        Prevalence of nosocomial infections in The Netherlands, 2007-2008: results of the first four national studies.
        The Journal of hospital infection. 2010; 75: 168-172https://doi.org/10.1016/j.jhin.2009.11.020
      1. VMS Veiligheidsprogramma. Prevention of CRBSI and treatment of severe sepsis (Voorkomen van lijnsepsis en behandeling van ernstige sepsis) February 2009 [Available from: https://www.vmszorg.nl/praktijkvoorbeelden-en-tools/praktijkgids-voorkomen-lijnsepsis-en-behandeling-ernstige-sepsis/.

        • 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.
        The New England journal of medicine. 2006; 355: 2725-2732https://doi.org/10.1056/NEJMoa061115
      2. Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D. Prevention of Central Line-Associated Bloodstream Infections Through Quality Improvement Interventions: A Systematic Review and Meta-analysis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2014 https://doi.org/10.1093/cid/ciu239.

        • van der Kooi T.
        • Sax H.
        • Pittet D.
        • van Dissel J.
        • van Benthem B.
        • Walder B.
        • et al.
        Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections.
        Intensive care medicine. 2018; 44: 48-60https://doi.org/10.1007/s00134-017-5007-6
        • Ista E.
        • van der Hoven B.
        • Kornelisse R.F.
        • van der Starre C.
        • Vos M.C.
        • 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.
        The Lancet Infectious diseases. 2016; 16: 724-734https://doi.org/10.1016/S1473-3099(15)00409-0
        • Furuya E.Y.
        • Dick A.
        • Perencevich E.N.
        • Pogorzelska M.
        • Goldmann D.
        • Stone P.W.
        Central line bundle implementation in US intensive care units and impact on bloodstream infections.
        PloS one. 2011; 6e15452https://doi.org/10.1371/journal.pone.0015452
        • Freixas N.
        • Bella F.
        • Limon E.
        • Pujol M.
        • Almirante B.
        • Gudiol F.
        Impact of a multimodal intervention to reduce bloodstream infections related to vascular catheters in non-ICU wards: a multicentre study.
        Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2013; 19: 838-844https://doi.org/10.1111/1469-0691.12049
        • Garcia-Rodriguez J.F.
        • Alvarez-Diaz H.
        • Vilarino-Maneiro L.
        • Lorenzo-Garcia M.V.
        • Canton-Blanco A.
        • Ordonez-Barrosa P.
        • et al.
        Epidemiology and impact of a multifaceted approach in controlling central venous catheter associated blood stream infections outside the intensive care unit.
        BMC infectious diseases. 2013; 13: 445https://doi.org/10.1186/1471-2334-13-445
        • Klintworth G.
        • Stafford J.
        • O'Connor M.
        • Leong T.
        • Hamley L.
        • Watson K.
        • et al.
        Beyond the intensive care unit bundle: Implementation of a successful hospital-wide initiative to reduce central line-associated bloodstream infections.
        American journal of infection control. 2014; 42: 685-687https://doi.org/10.1016/j.ajic.2014.02.026
        • Wei A.E.
        • Markert R.J.
        • Connelly C.
        • Polenakovik H.
        Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle.
        J Infect Prev. 2021; 22: 186-193https://doi.org/10.1177/17571774211012471
        • Scholten H.J.
        • Ten Bloemendal E.
        • Botter B.
        • Korsten H.H.M.
        • Bouwman R.A.
        Barriers to ultrasound guidance for central venous access: a survey among Dutch intensivists and anaesthesiologists.
        J Clin Monit Comput. 2019; 33: 1023-1031https://doi.org/10.1007/s10877-018-00246-z
        • Bion J.
        • Richardson A.
        • Hibbert P.
        • Beer J.
        • Abrusci T.
        • McCutcheon M.
        • et al.
        'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England.
        BMJ quality & safety. 2013; 22: 110-123https://doi.org/10.1136/bmjqs-2012-001325
        • van Daalen F.V.
        • Hulscher M.
        • Minderhoud C.
        • Prins J.M.
        • Geerlings S.E.
        The antibiotic checklist: an observational study of the discrepancy between reported and actually performed checklist items.
        BMC infectious diseases. 2018; 18: 16https://doi.org/10.1186/s12879-017-2878-7