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Analyzing central-line associated bloodstream infection prevention bundles in 22 countries: The results of ID-IRI survey

Published:March 06, 2022DOI:https://doi.org/10.1016/j.ajic.2022.02.031

      Highlights

      • Forty-three participants from 22 countries (46 hospitals, 85 intensive care units) responded to the survey.
      • Eight (17.4%) hospitals had no surveillance system for CLABSI.
      • Approximately 7.1 % (n = 6) had no CLABSI bundle and twenty intensive care units (23.5%) had no dedicated checklist.
      • The proportion of using ultrasonography during catheter insertion, transparent semi-permeable dressings, needleless connectors and single-use sterile pre-filled ready to use 0.9% NaCl were significantly higher in higher and middle higher countries.

      Background

      Because central line-associated bloodstream infections (CLABSIs) are a significant complication of central venous access, it is critical to prevent CLABSIs through the use of central line bundles. The purpose of this study was to take a snapshot of central venous access bundles in various countries.

      Methods

      The participants in intensive care units (ICUs) completed a questionnaire that included information about the health center, infection control procedures, and central line maintenance. The countries were divided into 2 groups: those with a low or low-middle income and those with an upper-middle or high income.

      Results

      Forty-three participants from 22 countries (46 hospitals, 85 ICUs) responded to the survey. Eight (17.4%) hospitals had no surveillance system for CLABSI. Approximately 7.1 % (n = 6) ICUs had no CLABSI bundle. Twenty ICUs (23.5%) had no dedicated checklist. The percentage of using ultrasonography during catheter insertion, transparent semi-permeable dressings, needleless connectors and single-use sterile pre-filled ready to use 0.9% NaCl were significantly higher in countries with higher and middle-higher income (P < .05).

      Conclusions

      Our study demonstrated that there are significant differences in the central line bundles between low/low-middle income countries and upper-middle/high-income countries. Additional measures should be taken to address inequity in the management of vascular access in resource-limited countries.

      Key Words

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      References

        • Devrim I
        • Yasar N
        • Isguder R
        • et al.
        Clinical impact and cost-effectiveness of a central line bundle including split-septum and single-use prefilled flushing devices on central line–associated bloodstream infection rates in a pediatric intensive care unit.
        Am J Infect Control. 2016; 44: e125-e128
        • Erdem H
        • Inan A
        • Altindis S
        • et al.
        Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran - A prospective multicenter point prevalence study.
        J Infect. 2014; 68: 131-140
        • Erdem H
        • Dizbay M
        • Karabey S
        • et al.
        Withdrawal of Staphylococcus aureus from intensive care units in Turkey.
        Am J Infect Control. 2013; 41: 1053-1058
        • Ullman AJ
        • Marsh N
        • Mihala G
        • Cooke M
        • Rickard CM
        Complications of central venous access devices: a systematic review.
        Pediatrics. 2015; 136: e1331-e1344
        • Beth M
        • Davis H
        Pediatric central venous catheter management.
        J Vasc Access [Internet]. 2013; 18: 93-98
        • Rosenthal VD
        • Guzman S
        • Orellano PW
        Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay.
        Am J Infect Control. 2003; 31: 291-295
        • NIH
        2021 Infusion therapy standards of practice updates.
        J Infus Nurs. 2021; 44: 89-190
      1. Aires B International Nosocomial Infection Control Consortium (INICC) care bundles to prevent central and peripheral line-related bloodstream infections. 2017; Accessed March 20, 2022. http://www.inicc.org/media/docs/2017-INICCBSIPreventionGuidelines.pdf

        • O'Grady NP
        • Alexander M
        • Dellinger EP
        • et al.
        Guidelines for the prevention of intravascular catheter-related infections. Centers for disease control and prevention.
        MMWR Recomm Rep. 2002; 51: 1-29
        • Mermel LA
        • Allon M
        • Bouza E
        • et al.
        Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection.
        ClinInfectDis. 2014; 49: 1-45
        • Rosenthal VD
        • Desse J
        • Maurizi DM
        • et al.
        Impact of the International Nosocomial Infection Control Consortium (INICC)’s multidimensional approach on rates of central line-associated bloodstream infection in 14 intensive care units in 11 hospitals of 5 cities in Argentina.
        Infect Control Hosp Epidemiol. 2018; 39: 445-451
        • Al-Abdely HM
        • Alshehri AD
        • Rosenthal VD
        • et al.
        Prospective multicentre study in intensive care units in five cities from the Kingdom of Saudi Arabia: impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of central line-associated bloodstream in.
        J Infect Prev. 2017; 18: 25-34
        • Alp E
        • Cookson B
        • Erdem H
        • et al.
        Infection control bundles in intensive care: an international cross-sectional survey in low-middle income countries.
        J Hosp Infect. 2019; 101: 248-256
      2. The World Bank. World Bank Country and Lending Groups. Available at:https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed December 13, 2021

        • Valencia C
        • Hammami N
        • Agodi A
        • et al.
        Poor adherence to guidelines for preventing central line-associated bloodstream infections (CLABSI): Results of a worldwide survey.
        Antimicrob Resist Infect Control [Internet]. 2016; 5: 49
        • Laurance J
        Peter Pronovost: champion of checklists in critical care.
        Lancet [Internet]. 2009; 374: 443
        • Wichmann D
        • Belmar Campos CE
        • Ehrhardt S
        • et al.
        Efficacy of introducing a checklist to reduce central venous line associated bloodstream infections in the ICU caring for adult patients.
        BMC Infect Dis. 2018; 18: 267
        • Ider BE
        • Adams J
        • Morton A
        • et al.
        Using a checklist to identify barriers to compliance with evidence-based guidelines for central line management: a mixed methods study in Mongolia.
        Int J Infect Dis [Internet]. 2012; 16: e551-e557
        • Rosenthal VD
        Device-associated nosocomial infections in limited-resources countries: Findings of the International Nosocomial Infection Control Consortium (INICC).
        Am J Infect Control. 2008; 36 (S171.e7-S171.e12)
        • Yilmaz G
        • Caylan R
        • Aydin K
        • Topbas M
        • Koksal I
        Effect of education on the rate of and the understanding of risk factors for intravascular catheter–related infections.
        Infect Control Hosp Epidemiol. 2007; 28: 689-694https://doi.org/10.1086/517976
        • Devrim İ
        • Oruç Y
        • Demirağ B
        • et al.
        Central line bundle for prevention of central line–associated bloodstream infection for totally implantable venous access devices (ports) in pediatric cancer patients.
        J Vasc Access. 2018; 19: 358-365
        • Rosenthal VD
        • Udwadia FE
        • Kumar S
        • et al.
        Clinical impact and cost-effectiveness of split-septum and single-use prefilled flushing device vs 3-way stopcock on central line-associated bloodstream infection rates in India: a randomized clinical trial conducted by the International Nosocomial Infect.
        Am J Infect Control [Internet]. 2015; 43: 1040-1045
        • Dolan SA
        • Arias KM
        • Felizardo G
        • et al.
        APIC position paper: safe injection, infusion, and medication vial practices in health care.
        Am J Infect Control [Internet]. 2016; 44: 750-757
        • Hadaway L
        Stopcocks for infusion therapy: evidence and experience.
        J Infus Nurs. 2018; 41: 24-34