Multi-faceted interventions key to reducing hospital-acquired infections, literature review shows

Clinicians, health care facilities and government agencies have worked together to make great strides in reducing rates of hospital-acquired infections over the past decade.

However, despite these improvements, individual hospitals still vary greatly in how they’re doing at preventing these infections.

A new review by a team from the Medical School’s Division of General Medicine – including several IHPI members – looks the academic literature to determine what is working in infection prevention in order to help hospitals tailor their infection prevention efforts. It's published in the Journal of Hospital Medicine. 

The researchers looked at all studies in intensive care units (ICUs) that aimed to reduce central line-associated bloodstream infection (CLABSI) and/or catheter-associated urinary tract infection (CAUTI). They found 102 studies for CLABSI and 28 studies for CAUTI.

To categorize the studies, they adapted a conceptual model. The model broke down the “life cycle” of the catheter into stages:

• stage 0, avoid catheter if possible;
• stage 1, ensure aseptic placement;
• stage 2, maintain awareness and proper care of catheters in place; and
• stage 3, promptly remove unnecessary catheters.

Among the most successful studies, interventions that addressed multiple stages in the catheter “life cycle” were common. Auditing was another common characteristic of the successful interventions. For CLABSI specifically, using a checklist when inserting catheters was frequently associated with success. For CAUTI, focusing on catheter removal as well as engaging a multidisciplinary team including nurse leadership were common amongst successful studies.

The review will help inform infection prevention strategies for a large-scale implementation project funded by the Agency for Healthcare Research and Quality.

The study’s authors are Payal K. Patel, MD, MPH , Ashwin Gupta, MD, Valerie M. Vaughn, MD, Jason D. Mann, MSA, Jessica M. Ameling, MPH, and Jennifer Meddings, MD, MSc.

Reference: Journal of Hospital Medicine, doi:10.12788/jhm.2856