A study examines the impact of interventions on lowering central line-associated bloodstream infection rates.

The cause of central line-associated bloodstream infections (CLABSIs) is multifaceted, and prevention is a primary concern in maintaining a high standard of hospital care. A post-COVID sustained increase in the incidence of CLABSIs was scrutinized in a study developed by Rebecca Bartles, DrPH, CIC, FAPIC, and colleagues. This research team conducted standardized on-site assessments at 11 healthcare facilities.

These on-site assessments were hands-on interventions that consisted of thorough preassessment investigations and interviews, case reviews, practice observations, in-hospital staff interviews, and post-assessment support for additional interventions. Post-assessment data from 9 of 11 facilities was deemed substantial enough to analyze and determine the interventions’ impact on decreasing CLABSIs.

Six months before the start of the study’s interventions, the overall CLABSI rate at the 9 facilities analyzed was 1.42 (infections per 1000-line days). Six months following the interventions, the rate was reduced to 0.44, indicating a 70% reduction in infections. Dr. Bartles and colleagues concluded that facility-specific investigation and targeted performance improvements reduced the CLABSI rate.

Overall, infections declined from 88 during the pre-assessment to 26 in the post-assessment period. Dr. Braun and colleagues reported that only one of the nine facilities did not see a decline in infections during the post-assessment period compared with the 6 months prior to the on-site assessment. Further, those CLABSIs all happened during the first 3 months after the on-site assessment, and no additional infections were reported in the 4 months after.

Dr. Bartles published the study in the Journal of Infusion Nursing and discussed its findings with Physician’s Weekly (PW).

PW: Why did you feel this topic needed exploration?

Dr. Bartles: Immediately after the COVID-19 pandemic began, rates of CLABSI rose significantly in the United States. Following a decline in COVID-19 cases, CLABSI did not return to pre-COVID rates. It was important for our facilities to determine why rates didn’t drop as expected, and we felt it important to share this information with others in healthcare who were experiencing a similar situation.

What are the most important findings from your study?

The increase in healthcare-associated infections (HAIs) associated with the COVID-19 pandemic was at least in part caused by small, likely incremental changes to multiple existing processes. Because of the crisis-level conditions during COVID-19, routine practices (ie, bathing, room cleaning, rounding, etc.) were often deprioritized or adjusted to require less time and effort. An accumulation of these small changes likely had a negative impact on overall HAI rates.

How can these findings be incorporated into practice?

Facilities still experiencing higher than historical HAI rates following the COVID-19 pandemic should consider reviewing basic clinical practices. The focus should be on patient hygiene, culture ordering and collection practices, environmental cleaning, and catheter care. Ensuring these basic interventions are hard-wired can go a long way toward prevention.

Is there anything else you would like to mention?

Although this article focused on CLABSI, similar on-site assessment efforts occurred regarding increased CAUTI (Catheter-Associated Urinary Tract Infection) rates. Findings were similar, and improvements in patient hygiene, culture ordering, and culture collection practices resulted in decreased CAUTI rates. In both cases, direct observation of processes and open-ended interviews with front-line staff were the best methods to identify opportunities for improvement.