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 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.
Faculty of Medicine and Health Sciences, Ghent University.
Koen
K
Blot
Health Economics and Patient Safety, Hasselt University, Hasselt, Belgium.
Jochen
J
Bergs
Faculty of Medicine and Health Sciences, Ghent University General Internal Medicine, Ghent University Hospital, Ghent.
Dirk
D
Vogelaers
Faculty of Medicine and Health Sciences, Ghent University Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
Stijn
S
Blot
Faculty of Medicine and Health Sciences, Ghent University General Internal Medicine, Ghent University Hospital, Ghent Health Economics and Patient Safety, Hasselt University, Hasselt, Belgium.
Dominique
D
Vandijck
D001521:Behavior Therapy / Q000379:methods*; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D058996:Quality Improvement; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control*
catheter-related bloodstream infection; central line–associated bloodstream infection; meta-analysis; quality improvement intervention