In the Journals

Reducing unneeded central venous catheter use prevents CLABSIs

A systematic literature review showed that interventions to reduce unnecessary central venous catheter use can significantly decrease the rate of central-line-associated bloodstream infections, or CLABSIs, in patients and should be considered for implementation by health care providers, researchers wrote in Infection Control & Hospital Epidemiology.

According to the CDC, CLABSIs lead to thousands of deaths each year and cost the United States health care system billions of dollars in added costs. Although there are guidelines and tools in place to prevent CLABSIs, there are still an estimated 30,000 to 40,000 of these infections annually.

“Central-line-associated bloodstream infections have long been among the most common forms of healthcare-associated infections. They are associated with increased morbidity, mortality, length of stay, and health care costs,” wrote Zhaoyu Xiong, MD, of the School for Nursing at Shanghai Jiao Tony University, and Haiyan Chen, from Xinhua Hospital.

“The development of CLABSIs is directly related to the use of central venous catheters (CVCs) and the CLABSI rate increases with the prolonged catheter dwell time,” they added. “However, in recent studies, CVCs were frequently retained unnecessarily because of inappropriate placement, or they were not removed promptly. Thus, interventions that reduce unnecessary CVC use may enhance the comfort and safety of patients.”

For their review, the authors collected experimental and observational studies from PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and the Cumulative Index to Nursing and Allied Health up to Aug. 28, 2018. They included all studies that implemented interventions to reduce unnecessary CVC use.

The 1,892 citations identified by the review included one randomized controlled trial (RCT), nine quasi-experimental studies and four cohort studies, according to the authors. Among them, 13 studies demonstrated a decrease in CVC use after intervention, with reduction rates ranging from 6.8% to 85%, the review showed. Among seven studies that reported the incidence of CLABSIs, there were reductions in in the infections ranging from 24.4% to 100%. The authors reported that the prevalence of unnecessary CVC use documented in the studies ranged between 4.6% and 32.7%.

They said data on secondary outcomes — including compliance with interventions, catheter-related noninfectious complications, hospital-related outcomes and cost — were limited, but results of a descriptive analysis showed 70% to 84% compliance, less catheter occlusion, shorter duration of hospitalization and cost savings.

“Interventions to reduce unnecessary CVC use significantly decrease the rate of CLABSIs,” the authors concluded. “Health care providers should strongly consider implementing interventions to avoid CVC use (eg, alternatives to CVCs or restriction of CVC insertion) and/or to ensure prompt removal of unnecessary CVCs. More RCTs with uniform definitions and outcome measures regarding CVC use and CLABSI rates are needed to comprehensively assess the effectiveness and safety of these interventions.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.

A systematic literature review showed that interventions to reduce unnecessary central venous catheter use can significantly decrease the rate of central-line-associated bloodstream infections, or CLABSIs, in patients and should be considered for implementation by health care providers, researchers wrote in Infection Control & Hospital Epidemiology.

According to the CDC, CLABSIs lead to thousands of deaths each year and cost the United States health care system billions of dollars in added costs. Although there are guidelines and tools in place to prevent CLABSIs, there are still an estimated 30,000 to 40,000 of these infections annually.

“Central-line-associated bloodstream infections have long been among the most common forms of healthcare-associated infections. They are associated with increased morbidity, mortality, length of stay, and health care costs,” wrote Zhaoyu Xiong, MD, of the School for Nursing at Shanghai Jiao Tony University, and Haiyan Chen, from Xinhua Hospital.

“The development of CLABSIs is directly related to the use of central venous catheters (CVCs) and the CLABSI rate increases with the prolonged catheter dwell time,” they added. “However, in recent studies, CVCs were frequently retained unnecessarily because of inappropriate placement, or they were not removed promptly. Thus, interventions that reduce unnecessary CVC use may enhance the comfort and safety of patients.”

For their review, the authors collected experimental and observational studies from PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and the Cumulative Index to Nursing and Allied Health up to Aug. 28, 2018. They included all studies that implemented interventions to reduce unnecessary CVC use.

The 1,892 citations identified by the review included one randomized controlled trial (RCT), nine quasi-experimental studies and four cohort studies, according to the authors. Among them, 13 studies demonstrated a decrease in CVC use after intervention, with reduction rates ranging from 6.8% to 85%, the review showed. Among seven studies that reported the incidence of CLABSIs, there were reductions in in the infections ranging from 24.4% to 100%. The authors reported that the prevalence of unnecessary CVC use documented in the studies ranged between 4.6% and 32.7%.

They said data on secondary outcomes — including compliance with interventions, catheter-related noninfectious complications, hospital-related outcomes and cost — were limited, but results of a descriptive analysis showed 70% to 84% compliance, less catheter occlusion, shorter duration of hospitalization and cost savings.

“Interventions to reduce unnecessary CVC use significantly decrease the rate of CLABSIs,” the authors concluded. “Health care providers should strongly consider implementing interventions to avoid CVC use (eg, alternatives to CVCs or restriction of CVC insertion) and/or to ensure prompt removal of unnecessary CVCs. More RCTs with uniform definitions and outcome measures regarding CVC use and CLABSI rates are needed to comprehensively assess the effectiveness and safety of these interventions.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.