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 The study aims to establish the effect of adding simulation-based education in efforts to minimize central venous catheter-related bloodstream infections (CRBSI) in ICUs. The design of the study focuses on pre-and post-intervention retrospective observational investigation. Patients from a 24-bed ICU and 562-bed university-affiliated urban teaching hospital were used for the study. Measurement strategies focused on determining the rates of patient developing CRBSI from July 2004- June 2008. Pre-intervention educational program for staff and physicians began in 2004 with pre-and post-test being provided. In 2006, a simulation-based program was introduced and made mandatory for all healthcare personnel e.g. interns, residents and fellow physicians. Data collected pre-and post-intervention revealed a significant reduction of CRBSI incidence. The pre-intervention CRBSI incidence rate was 6.47 out of 1000 catheter day. The post-intervention rate reduced to 2.44 out of 1000 catheter days. The study concluded that the implementation of simulation-based education program was effective in reducing CRBSI incidence, and cost of patient care.

Berenholtz, S. M., Lubomski, L. H., & ... Pronovost, P. J. (2014). Eliminating Central Line-Associated Bloodstream Infections. Infection Control & Hospital Epidemiology, 35(1), 56-62. Doi: 10.1086/674384

The research was done with the purpose of determining whether “on the CUSP: Stop BSI” program was effective in minimize the prevalence of central line-associated bloodstream infections (CLABSIs). CLABSI is preventable and healthcare facilities to adopt measures that minimize their prevalence. A cohort study was conducted among participating patients in the ICU. The multilevel Poisson regression modeling was used to make a comparison of the rate of infection prior, during and after the initiation of the intervention strategy. Approximately 1071 ICUs reporting over 27, 000 IC months and over 4 million catheter days were included in the study that took 18 months. The findings of the research established a dropped in CLABSI rates, and by the end of the study period (18 months) the incidence ratio had decrease to 0.57. The study demonstrates the need for ICUs across different hospitals to implement the “on the CUSP: Stop BSI” program in order to minimize CLABSI rates.

Furuya, E., Dick, A., & Stone, P. (2011). Central line bundle implementation in US ICUs and impact on bloodstream infections. Plos One, 6(1), e15452. Doi:10.1371/journal.pone.0015452

The research was to examine the use of the adoption of the CL bundle in intensive care units across US.  Central line bundle elements are becoming a preference in healthcare settings with researchers acknowledging that they aid in minimizing CLABSI rates. Additionally, the study aimed to determine the effectiveness of each bundle element, in reducing infections. Similarly, the study aimed to establish the effectiveness of using a combination of bundle elements in reducing the prevalence of infections. 250 hospitals participated in the observational study with multivariate analysis being conducted on each of the participating hospitals. The findings of the research indicated that only 38% of hospitals have a CL bundle policy that they utilize. The findings mean that the availability of a CL bundle within a healthcare facility does not mean that CLABSI rates will reduce. The study reveals a need for hospitals to implement CL bundle policies and ascertain that physicians comply with the guidelines of the policy.

Helder, O., Kornelisse, R, Wijnen, R., & ... Ista, E. (2013). Implementation of a children's hospital-wide CVC insertion and maintenance bundle. BMC Health Services Research, 13(1), 1-22. Doi: 10.1186/1472-6963-13-417

The study aims to obtain solid evidence for an effective method of minimizing CABSIs. Specifically, the study focuses on the insertion of central venous catheters (CVC) using the Pronovost-model as the guide. The study utilizes an interrupted time series (ITS) as the study design. ITS will be implemented over a period of three months and in three phases: pre-intervention, intervention and post-intervention. All wards at Erasmus MC-Sophia children’s hospitals with the exception of the day-care wards were used as participants. The outcome of the intervention was measures according to the number of CLABSI cases per 1000-line days. The Pronovost-model was effective in assisting in establishing design strategies, in relation to the reduction of CLABSIs. The Pronovost-model presented effective strategies such as education, organizational change and the use of ICT such as timers during CVC processes. The model also encourages the involvement of stakeholders involved in patient care so as to discuss potential barriers in the adoption of the ideal protocol.

Gonzales, M., Rocher, I., Tremblay, C., & ... Quach, C. (2013). A survey of Preventive Measures Used and their Impact on CLABSI in Intensive Care Units (SPINBACC). BMC Infectious Diseases, 13(1), 1-14. Doi: 10.1186/1471-2334-13-562

The study aims to determine the preventive measure adopted in ICUs in Quebec in relation to the prevention of CLABSI. Additionally, the study aims to determine whether the compliance to the selected preventive measure was monitored thus effective in minimizing the prevalence of CLABSIs. A voluntary survey was sent to participating hospitals with hospitals which consent to the study responding to 77 question cross-sectional surveys. 48 hospitals were approved for the study. A descriptive analysis was used to establish the variable with Poisson regression being used to estimate the change of infection rates. The findings of the study revealed that compliance monitoring is not yet widespread in ICUs, in Quebec. However, the study revealed that a majority of hospitals in Quebec have implemented preventive measures to curb CLABSI. The study presents an in-depth understanding of effective measures that hospitals in Quebec are using so as to minimize the prevalence of CLABSI. The research also illustrates the importance of monitoring to ascertain that the CVC process adheres to adopted preventive programs.

Longmate, A., Ellis, K., Boyle, L., Maher, S., Cairns, C., Lloyd, S., & Lang, C. (2011). Elimination of central-venous-catheter-related bloodstream infections from the ICU. BMJ Quality & Safety, 20(2), 174-180. Doi:10.1136/bmjqs.2009.037200

The study aims to establish ideal interventions that will minimize the prevalence of CRBSI in ICUs. The researchers established a supportive setting that was open to change and improvement. The researchers also established a surveillance system so as to track the rate of infection. Additionally, bundles of care processes with regard to CVC insertion and maintenance were introduced. Researchers also introduced educational interventions aimed at minimizing rates of infections. Statistical-process control charts were used to illustrate the outcomes and changes related to insertion and maintenance of CVCs. The findings of the 18 month-long study revealed that the annual CRBSI rate dropped to zero infections per 1000 patient days. The success of the study is an indicator that other healthcare institutions should attempt to implement some of the intervention strategies. CVC blood-related infections are preventable through the adoption of a quality improvement approach aimed at improvement the insertion and maintenance of catheters.

Chopra, V., O'Horo, J. C., M., Maki, D. G., & Safdar, N. (2013). The Risk of Bloodstream Infection Associated with Peripherally Inserted Central Catheters Compared with Central Venous Catheters in Adults: A Systematic Review and Meta-Analysis. Infection Control & Hospital Epidemiology, 34(9), 908-918. Doi: 10.1086/671737

The research makes a comparative analysis of the risk of CLABSI between peripherally inserted central catheters (PICC0 and central venous catheters (CVC). The study focused on the analysis of different scholarly texts and researches that related to the objective of the study. Full-text studies from databases such as Medline, CINAHL, and EmBASE were used. The analysis also focused on research studies that involved adults who were over 18 years and had undergone the PICC or CVC insertion and had suffered from CLABSI. The random-effect meta-analyses were used to determine actual estimates of CLABSI risk. The results of the study revealed that PICCs have a lower risk of CLABSI than CVCs. However, the margin difference is quite minimal as inpatients may also experience CLABSI when using PICC or CVCs.  Overall, the study reveals the need for healthcare professionals to undertake a needs assessment and weigh the benefits over risk of PICC use before any catheterization procedure.

Pakyz, A. L., & Edmond, M. B. (2013). Influence of State Laws Mandating Reporting of Healthcare-Associated Infections. Infection Control & Hospital Epidemiology, 34(8), 780-784. Doi: 10.1086/671280

The research determines the effect of state laws on reporting of health-associated infection on CLABSI rates. The study adopted a retrospective cross-sectional study where hospital-level administration and hospital compare data were gathered.  The probit regression model was used to analyze the association between CLABSI legislation types and the hospital. 159 hospitals were included in the study. 92 hospitals met the 3 legal submission of data submission, reporting of data and presence of facility identifiers in public reports.  33 hospitals did not meet the three requirements while 34 hospitals did not have any legislation with regard to CLABSI prevention measures. The findings of the study revealed that HAI reporting laws had not effect on the incidence rates of CLABSI. These findings are an indicator that the existing HAI reporting laws need to be revised to include factors aimed at reducing CLABSI occurrences. The study had found that CLABSI occurrence in the participating hospitals was rampant.

Leekha, S., Shanshan, L., Thom, K. A., Preas, M., Caffo, B. S., Morgan, D. J., & Harris, A. D. (2013). Comparison of Total Hospital-Acquired Bloodstream Infections to Central Line-Associated Bloodstream Infections and Implications for Outcome Measures in Infection Control. Infection Control & Hospital Epidemiology, 34(9), 984-986. Doi: 10.1086/671730

The research was done with the purpose of determining the prevalence of hospital-acquired bloodstream infection (BSI) in relation to existing control measures. Hospitals are under pressure to report zero CLABSI in their facilities. The study was conducted using the longitudinal study of BSI trends. The study was conducted over a 5year period from 2007-2012 at the University of Maryland center. A 757-bed hospital with 333 ICU beds was selected as the setting of the study. The study population included 8 ICU adult patients. The Charlson score was used to measure co-morbidity while the case mix index was used to measure the severity of an infection. The study revealed that 14.3% of patients had CLABSI while 18.7% had non-contaminant BSI. The implementation of CLABSI intervention measure led a significant decline of CLABSI infections. This is contrast to the high rates recorded prior to the implementation of the interventions. The frequency of infection and the severity of illness also reduced after implementation of the intervention strategies. The study advocates for the establishment and integration of effective intervention methods within healthcare facilities.

Whited, A., & Lowe, J. M. (2013). CLABSI: Not Just an ICU Problem. Clinical Journal of Oncology Nursing, 17(1), 21-24. Doi:10.1188/13. CJON.21-24

The study analyzes different literatures with the aim of demonstrating that CLABSI are not confined to ICU-patients. Currently, CLABSI contribute to over $36,000 increased patients costs, it leads to extended hospitals stays and increases mortality rates.   Additionally, the prevalence of CLABSI is present in ICU and non-ICU patients. The study focused on different research studies which predominantly focused on ICU patients.  Each study revealed a significant reduction in prevalence rates after the introduction of preventive intervention measures such as education and training on catheter management, hygiene practices, and the use of a checklist during insertion. The review of literature determined that the rate of infection among ICU patients is similar to infection rates among non-ICU patients. Therefore, preventive interventions applicable in ICU setting apply in non-ICU setting. The prevention of CLABSI in non-ICU patients is essential as it will lead to a reduction of infections and the overall cost of maintenance. Healthcare providers must observe diligence in their practice and ascertain non-ICU patients are not affected by CLABSI.

Render, M., Hasselbeck, R., Freyberg, R., Hofer, T., Sales, A., &Almenoff, P. (2011). Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement. BMJ Quality & Safety, 20(8), 725-732. Doi:10.1136/bmjqs.2010.048462

The research describes how the implementation of a practice bundle can be effective in the reduction of CLABSI. Bundle practice involves the integration of practices such as use of sterile barriers, appropriate skin preparation procedures, and removal of lines that are not needed. The 174 Veteran’s administration (VA) ICUs served as the setting of the study. The VA-ICUs collected central line days and bloodstream infections from 2006. The data was analyzed using the statistical method of analysis of variance where comparison of rate of infection and adherence to centre line bundle was made. The incidence rate rations (IRR) compared CLABSI infections, in every year and the reference year of 2006. The study covered 833172 central line days from 2006 to 2009. The results of the study indicated a decline in CLABSI in VA. Other healthcare bodies can adopt the preventive measures that were applied in the VA facilities. The results further proved that an effective way in curbing CLABSI is by the inclusion of different strategies. Support systems such as a supportive leadership, the use of benchmark feedback and learning tools, and the implementation of selective monitoring are effective in minimizing CLABSI prevalence.

Rosenthal, V., Dueñas, L., Sobreyra-Oropeza, M., Ammar, K., Navoa-Ng, J., Concepción Bran, A., & ... V. (2013). Findings of the International Nosocomial Infection Control Consortium (INICC), Part III: Effectiveness of a Multidimensional Infection Control Approach to Reduce Central Line-Associated Bloodstream Infections in the Neonatal Intensive Care Units of 4 Developing Countries. Infection Control & Hospital Epidemiology, 34(3), 229-237. Doi: 10.1086/669511

The research determines the effect of INICC with regard to the prevention of CLABSI prevalence. The setting of the study was at 4 neonatal ICUs of hospitals from El Salvador, Mexico, Philippines and Tunisia. The selected hospitals were part of INICC. The participants of the study were 2,241 patients that had been admitted at the 4 ICUs. A before and after prospective surveillance study, with special reference to the implementation of control procedures such as the central line bundle, process surveillance, performance feedback and outcome surveillance, was performed. The random-effects Poisson regression was used to analyze the collected data. The results of the study revealed a 55% decline in CLABSI prevalence. The study highlights the importance of healthcare facilities adopting diverse preventive mechanisms aimed at reducing the rate of CLANSI. Appreciating the reality that CLABSI is a preventable hospital-acquired infection is an essential motivation that healthcare workers can use to effect changes in their working institutions.

Gaur, A. H., Miller, M. R., Gao, C., & Huskins, W. (2013). Evaluating Application of the National Healthcare Safety Network CLABSI Surveillance Definition: A Survey of Pediatric Intensive Care and Hematology/Oncology Units. Infection Control & Hospital Epidemiology, 34(7), 663-670. Doi: 10.1086/671005

The study aimed to evaluate the application of the national healthcare safety network (NHSN) central line associated infection (CLABSI) in pediatric ICUs and pediatric hematology or oncology unit. A majority of children in need of critical care require central venous catheters for the administration of medication, blood etc. the risk of CLABSI is high in such patients. The design of the study focused on an online survey that utilized 18 standardized case scenarios. Each case scenario consisted of a positive blood culture. The NHSN staff was required to respond with a yes or a no to whether the positive blood culture was indicative of CLASBI. The setting of the study was 65 pediatric ICUs and HOUS within the US. The participants were healthcare staff who handled blood tests and conducted CLABSI tests. They included preventionists, infection control offices and physicians. The studies revealed varied responses and reference standards across the different healthcare facilities. The variation in diagnosis was high despite the use of trained and experienced staff. The study concluded that healthcare facilities have a difficult time identifying CLABSI during admission. The difficult in detection makes it difficult to tell apart primary from secondary bloodstream infection.

Klieger, S. B., Potter-Bynoe, G., & Coffin, S. E. (2013). Beyond the Bundle: A Survey of Central Line--Associated Bloodstream Infection Prevention Practices Used in US and Canadian Pediatric Hospitals. Infection Control & Hospital Epidemiology, 34(11), 1208-1210. Doi: 10.1086/673447

The study aimed to determine pediatric hospitals use of CLABSI prevention strategies that went beyond insertion and maintenance strategies. There have been significant efforts towards the reduction of CLABSI in in-patient children. The design for the study was in the form of a web-based survey sent to 44 children hospitals (America) and 13 tertiary care facilities in Canada. Responses in the survey were structured to capture information on the practices that the facilities had adopted. 50 responses and 38 responses were received from Canada and US with nearly half of the respondent using an extra supplementary method of minimizing CLABSI infection. Most US facilities, for instance, use disinfectant dressing as a supplementary method of curbing infections. The studies revealed that the pediatric institution used additional prevention strategies. Interventions at exit sites and catheters were predominant. The supplementary strategies were used with the accepted CLABSI prevention bundles. This study highlights the need for healthcare facilities to adopt additional CLABSI prevention strategies that go beyond the standard preventive measures.  Additional, but effective preventive strategies will ascertain that healthcare facilities record zero occurrence of CLABSI.

Weeks, K., Goeschel, C., Cosgrove, S., Romig, M., & Berenholtz, S. (2011). Prevention of CLABSI: A journey toward eliminating preventable harm. Current Infectious Disease Reports 13(4), 343-349. Doi: 10.1007/s11908-011-0186-8

The study reviews the patho-physiology and microbiology of CLABSI. Additionally, the study reviews the successful efforts that have been implemented so as to prevent CLABSI prevalence. CLABSI is a preventable harm that can be managed through the adoption of effective prevention strategies. The study reviews the actual definition of CLABSI and how the infection can be differentiated from the catheter-related bloodstream infection. CLABSI is an infection that cannot be attributed to another secondary source. Definitions by CDC and NHSN are also provided. The causes of infection are also discussed in great depth. The article also analyzes effectors by the department of human health services to ensure healthcare facilities have zero CLABSI rates. Intervention strategies such as appropriate hand hygiene and use of sterile tools are discussed as some of the effective interventions in the prevention of CLABSI prevalence. The article also reviews the success of prevention program efforts in facilities such as Pittsburgh regional healthcare initiative and John Hopkins.  The success of these preventive programs is an indicator that the problem of CLABSI can be eliminated. This article provides readers with an improved understanding of CLABSI.

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