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Quality improvement report
Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates
  1. Jennifer Meddings1,2,3,4,
  2. M Todd Greene1,2,3,
  3. David Ratz1,3,
  4. Jessica Ameling2,3,
  5. Karen E Fowler1,3,
  6. Andrew J Rolle5,
  7. Louella Hung5,
  8. Sue Collier5,
  9. Sanjay Saint1,2,3
  1. 1 Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  3. 3 Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  4. 4 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
  5. 5 Health Research & Educational Trust, American Hospital Association, Chicago, Illinois, USA
  1. Correspondence to Dr Jennifer Meddings, Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA; meddings{at}umich.edu

Abstract

Background Preventing central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) remains challenging in intensive care units (ICUs).

Objective The Agency for Healthcare Research and Quality Safety Program for ICUs aimed to reduce CLABSI and CAUTI in units with elevated rates.

Methods Invited hospitals had at least one adult ICU with elevated CLABSI or CAUTI rates, defined by a positive cumulative attributable difference metric (CAD >0) in the Centers for Disease Control and Prevention’s Targeted Assessment for Prevention strategy. This externally facilitated programme implemented by a national project team and state hospital associations included on-demand video modules and live webinars reviewing a two-tiered approach for implementing key technical and socioadaptive factors to prevent catheter infections, using principles and tools based on the Comprehensive Unit-based Safety Program. CLABSI, CAUTI and catheter use data were collected (preintervention 13 months, intervention 12 months). Multilevel negative binomial models assessed changes in catheter-associated infection rates and catheter use.

Results Of 366 recruited ICUs from 220 hospitals in 16 states and Puerto Rico for two cohorts, 280 ICUs completed the programme including infection outcome reporting; 274 ICUs had complete outcome data for analyses. Statistically significant reductions in adjusted infection rates were not observed (CLABSI incidence rate ratio (IRR)=0.75, 95% CI 0.52 to 1.08, p=0.13; CAUTI IRR=0.79, 95% CI 0.59 to 1.06, p=0.12). Adjusted central line utilisation (IRR=0.97, 95% CI 0.93 to 1.00, p=0.09) and adjusted urinary catheter utilisation were unchanged (IRR=0.98, 95% CI 0.95 to 1.01, p=0.14).

Conclusion This multistate programme targeted ICUs with elevated catheter infection rates, but yielded no statistically significant reduction in CLABSI, CAUTI or catheter utilisation in the first two of six planned cohorts. Improvements in the interventions based on lessons learnt from these initial cohorts are being applied to subsequent cohorts.

  • healthcare quality improvement
  • infection control
  • nosocomial infections
  • patient safety
  • quality improvement
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjqs-2019-009330

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    Footnotes

    • Twitter @KFowler_PSEP

    • Funding This work was funded by a contract from the Agency for Healthcare Research and Quality (AHRQ) (Contract #HHSP233201500016I/HHSP23337002T). AHRQ provided contract funding, set program objectives and deliverables, provided guidance throughout the project, and coordinated with other federal agencies. AHRQ was not directly responsible for the implementation of the project. Additional support was received from the University of Michigan and the Department of Veterans Affairs National Center for Patient Safety. Dr. Meddings’ effort was initially partially funded by concurrent support from AHRQ (K08 HS19767).

    • Disclaimer The findings and conclusions in this report are those of the authors and do not represent the official position of the Agency for Healthcare Research and Quality, the US Department of Health and Human Services, or the Department of Veterans Affairs.

    • Competing interests JM has reported receiving honoraria for lectures and teaching related to prevention and value-based policies involving catheter-associated urinary tract infection and hospital-acquired pressure ulcers. SS has reported receiving honoraria for lectures and teaching related to prevention of catheter-associated urinary tract infection, and is on the medical advisory boards of Doximity and Jvion. JM and SS hold a provisional US patent on a technology to improve aseptic placement of urinary catheters, which was not part of this study.

    • Patient consent for publication Not required.

    • Ethics approval This study was deemed exempt from oversight by our institution’s institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. Analytic code available upon request to the corresponding author.

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