title: Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): results of a worldwide survey.
abstract: BACKGROUND
  Central line-associated bloodstream infections (CLABSI) are a cause of increased morbidity and mortality, and are largely preventable. We documented attitudes and practices in intensive care units (ICUs) in 2015 in order to assess compliance with CLABSI prevention guidelines.
  
  
  METHODS
  Between June and October 2015, an online questionnaire was made available to medical doctors and nurses working in ICUs worldwide. We investigated practices related to central line (CL) insertion, maintenance and measurement of CLABSI-related data following the SHEA guidelines as a standard. We computed weighted estimates for high, middle and low-income countries using country population as a weight. Only countries providing at least 10 complete responses were included in these estimates.
  
  
  RESULTS
  Ninety five countries provided 3407 individual responses; no low income, 14 middle income (MIC) and 27 high income (HIC) countries provided 10 or more responses. Of the total respondents, 80% (MIC, SE = 1.5) and 81% (HIC, SE = 1.0) reported availability of written clinical guidelines for CLABSI prevention in their ICU; 23% (MIC,SE = 1.7) and 62% (HIC,SE = 1.4) reported compliance to the following (combined) recommendations for CL insertion: hand hygiene, full barrier precaution, chlorhexidine >0.5%, no topic or systemic antimicrobial prophylaxis; 60% (MIC,SE = 2.0) and 73% (HIC,SE = 1.2) reported daily assessment for the need of a central line. Most considered CLABSI measurement key to quality improvement, however few were able to report their CLABSI rate. Heterogeneity between countries was high and country specific results are made available.
  
  
  CONCLUSIONS
  This study has identified areas for improvement in CLABSI prevention practices linked to CL insertion and maintenance. Priorities for intervention differ between countries.
authors.affiliation: Healthcare Associate Infections Unit, Scientific Institute of Public Health, Brussels, Belgium.|European Programme for Interventional Epidemiology Training (EPIET), ECDC, Stockholm, Sweden.
authors.forename: Cristina
authors.identifier: 0000-0003-0008-4980
authors.initials: C
authors.lastname: Valencia
authors.affiliation: Healthcare Associate Infections Unit, Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Naïma
authors.initials: N
authors.lastname: Hammami
authors.affiliation: Department GF Ingrassia, University of Catania, Catania, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Agodi
authors.affiliation: Department Anaesthesia, General Intensive Care, University hospital, Lyon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Lepape
authors.affiliation: Intensive Care department, Hospital Universitario "Infanta Leonor", Madrid, Spain.
authors.forename: Eduardo Palencia
authors.initials: EP
authors.lastname: Herrejon
authors.affiliation: Department of Internal Medicine, Ghent University, Ghent, Belgium.
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
authors.affiliation: Department of Intensive Care, Erasme University, Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Healthcare Associate Infections Unit, Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Marie-Laurence
authors.initials: ML
authors.lastname: Lambert
keywords: Bloodstream infections; Central line-associated bloodstream infections; Healthcare associated infection; Intensive care units; Preventive practices; Surveillance