Use of a Central Catheter Maintenance Bundle in Long-Term Acute Care Hospitals

Antony M Grigonis; Amanda M Dawson; Mary Burkett; Arthur Dylag; Matthew Sears; Betty Helber; Lisa K Snyder

doi:10.4037/ajcc2016894

Use of a Central Catheter Maintenance Bundle in Long-Term Acute Care Hospitals

Am J Crit Care. 2016 Mar;25(2):165-72. doi: 10.4037/ajcc2016894.

Authors

Antony M Grigonis¹, Amanda M Dawson², Mary Burkett², Arthur Dylag², Matthew Sears², Betty Helber², Lisa K Snyder²

Affiliations

¹ Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC. agrigonis@selectmedical.com.
² Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC.

PMID: 26932919
DOI: 10.4037/ajcc2016894

Abstract

Objective: Evidence-based guidelines have resulted in decreases in bloodstream infections associated with central catheters (CLABSIs) in hospital intensive care units. However, relatively little is known about CLABSI incidence and prevention in long-term acute care hospitals (LTACHs).

Methods: A central catheter maintenance bundle was implemented in 30 LTACHs, and compliance with the bundle was tracked for 6 months. CLABSI rates were monitored for 14 months before and 14 months after the bundle was implemented.

Results: The pooled mean CLABSI rate (No. of infections per 1000 days with a central catheter) was 1.28 before the bundle and 0.96 after the bundle (repeated measures general linear model; F1,58 = 6.973; P = .01; partial η(2) = .11). From 14 months before to 14 months after the bundle was implemented, the mean number of CLABSIs per LTACH decreased by 4.5 (95% CI, 1.85-7.15). Time series modeling showed a significant decrease in the mean hospital CLABSI rate after the bundle was implemented (-0.511 CLABSI/1000 catheter days, SE = 0.050), indicating an immediate effect of the bundle. The mean hospital CLABSI rate was decreasing slightly before the bundle was implemented and continued to decrease at a reduced rate after the bundle was implemented.

Conclusion: The bundle resulted in a significant and sustained reduction in CLABSI rates in 30 LTACHs for 14 months. These results encourage the development and implementation of similar bundles as effective strategies for infection reduction in LTACHs.

Publication types

Multicenter Study

MeSH terms

Catheter-Related Infections / prevention & control*
Catheterization, Central Venous / instrumentation*
Catheterization, Central Venous / methods*
Cross Infection / prevention & control*
Humans
Infection Control / instrumentation
Infection Control / methods*
Intensive Care Units*
Long-Term Care / methods
Practice Guidelines as Topic