Improving CVC Insertion Results in Significant and Sustained CLABSI Reduction

Central line-associated bloodstream infection (CLABSI) is an avoidable complication in central venous catheter (CVC) use. Investigators from the University of Geneva Hospitals in Switzerland prospectively observed individual CVCs hospital-wide in all adult patients.

 

A baseline period (September 2006 through December 2006) was followed by an intervention (January 2008 through December 2008) and a sustainability period (January 2009 through December 2009). Primary outcome was CLABSI. Interventions were aimed at catheter insertion by anesthesiologists and included a comprehensive checklist, a ready-to-use CVC-insertion set, a CVC-insertion cart containing all necessary material, self-assessment of insertion practice using online documentation, simulation-based CVC-insertion training for residents, web-based information site and feedback during postgraduate education. No intervention was done outside the anesthesiology division.

Anesthesiologists, intensivists and other physicians placed 1,665 (42 percent), 1,693 (43 percent), and 617 (15 percent) catheters, respectively. Cumulative catheter-days and median (IQR) dwell-time were 35,914 and six (3-11) days, respectively. Most CVCs were jugular (62 percent), followed by subclavian (23 percent) and femoral (15 percent). CLABSI-rates of anaesthesiologists, intensivists and others at baseline, intervention and sustainability were 4.9, 2.9, 2.0 (IRR 0.75; 95%CI 0.57-0.99; p=0.04); 2.7, 1.4, 2.2 (0.96; 95%CI 0.63-1.46; p=0.85); and 1.6, 2.1, 3.9 (1.54; 95%CI 0.83-2.84; p=0.17), respectively.

Zingg, et al. concluded that improving CVC-insertion results in significant and sustained CLABSI-reduction. The researchers consider self-assessment at catheter insertion and simulation-based training to have contributed most to the success. Their research was presented at the International Conference on Prevention & Infection Control (ICPIC) held in Geneva, Switzerland June 29-July 2, 2011.

Reference: W Zingg, V Cartier, C Inan, S Touveneau, F Clergue, D Pittet and B Walder. Sustained reduction of catheter-associated bloodstream infections by simulator-training and self-assessment. Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):O13