Prevention of Central Line–Associated Bloodstream Infections Through Quality Improvement Interventions: A Systematic Review and Meta-analysis

This systematic review and meta-analysis examines the impact of quality improvement interventions on central line–associated bloodstream infections in adult intensive care units. Studies were identified through Medline and manual searches (1995–June 2012). Random-effects meta-analysis obtained poole...

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Bibliographic Details
Published in:Clinical infectious diseases 2014-07, Vol.59 (1), p.96-105
Main Authors: Blot, Koen, Bergs, Jochen, Vogelaers, Dirk, Blot, Stijn, Vandijck, Dominique
Format: Article
Language:English
Subjects:
Bacterial diseases
Bacterial sepsis
Behavior Therapy - methods
Biological and medical sciences
Blood
Catheter-Related Infections - epidemiology
Catheter-Related Infections - prevention & control
Catheterization
Catheters
Central venous catheterization
Clinical outcomes
Cross Infection - prevention & control
Educational improvement
Human bacterial diseases
Humans
Infections
Infectious diseases
Intensive care units
Invited
Medical sciences
Meta-analysis
Nosocomial infections
Preventive maintenance
Psychoeducational intervention
QUALITY IMPROVEMENT
Quality of care
Sepsis - epidemiology
Sepsis - prevention & control
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Summary:This systematic review and meta-analysis examines the impact of quality improvement interventions on central line–associated bloodstream infections in adult intensive care units. Studies were identified through Medline and manual searches (1995–June 2012). Random-effects meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Meta-regression assessed the impact of bundle/checklist interventions and high baseline rates on intervention effect. Forty-one before–after studies identified an infection rate decrease (OR, 0.39 [95% CI, .33–.46]; P < .001). This effect was more pronounced for trials implementing a bundle or checklist approach (P = .03). Furthermore, meta-analysis of 6 interrupted time series studies revealed an infection rate reduction 3 months postintervention (OR, 0.30 [95% CI, .10–.88]; P = .03). There was no difference in infection rates between studies with low or high baseline rates (P = .18). These results suggest that quality improvement interventions contribute to the prevention of central line–associated bloodstream infections. Implementation of care bundles and checklists appears to yield stronger risk reductions.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciu239