Impact of a Multidisciplinary Infection Prevention Initiative on Central Line and Urinary Catheter Utilization in a Long-term Acute Care Hospital

Suganya Chandramohan; Bhagyashri Navalkele; Ammara Mushtaq; Amar Krishna; John Kacir; Teena Chopra

doi:10.1093/ofid/ofy156

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 Jul 26;5(7):ofy156. doi: 10.1093/ofid/ofy156. eCollection 2018 Jul.

Authors

Suganya Chandramohan¹, Bhagyashri Navalkele¹, Ammara Mushtaq², Amar Krishna¹, John Kacir³, Teena Chopra¹

Affiliations

¹ Division of Infectious Diseases, Detroit Medical Center/Wayne State University, Detroit, Michigan.
² Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan.
³ Kindred Hospital, Detroit, Michigan.

Abstract

Background: Prolonged central line (CL) and urinary catheter (UC) use can increase risk of central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI).

Methods: This interventional study conducted in a 76-bed long-term acute care hospital (LTACH) in Southeast Michigan was divided into 3 periods: pre-intervention (January 2015-June 2015), intervention (July-November 2015), and postintervention (December 2015-March 2017). During the intervention period, a multidisciplinary infection prevention team (MIPT) made weekly recommendations to remove unnecessary CL/UC or switch to alternate urinary/intravenous access. Device utilization ratios (DURs) and infection rates were compared between the study periods. Interrupted time series (ITS) and 0-inflated poisson (ZIP) regression were used to analyze DUR and CLABSI/CAUTI data, respectively.

Results: UC-DUR was 31% in the pre- and postintervention periods and 21% in the intervention period. CL-DUR decreased from 46% (pre-intervention) to 39% (intervention) to 37% (postintervention). The results of ITS analysis indicated nonsignificant decrease and increase in level/trend in DURs coinciding with our intervention. The CAUTI rate per catheter-days did not decrease during intervention (4.36) compared with pre- (2.49) and postintervention (1.93). The CLABSI rate per catheter-days decreased by 73% during intervention (0.39) compared with pre-intervention (1.45). Rates again quadrupled postintervention (1.58). ZIP analysis indicated a beneficial effect of intervention on infection rates without reaching statistical significance.

Conclusions: We demonstrated that a workable MIPT initiative focusing on removal of unnecessary CL and UC can be easily implemented in an LTACH requiring minimal time and resources. A rebound increase in UC-DURs to pre-intervention levels after intervention end indicates that continued vigilance is required to maintain performance.

Keywords: catheter-associated urinary tract infection; central line–associated blood stream infection; device utilization ratio; infection prevention; long-term acute care.