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Implementing a Multifaceted Intervention to Decrease Central Line–Associated Bloodstream Infections in SEHA (Abu Dhabi Health Services Company) Intensive Care Units: The Abu Dhabi Experience

Published online by Cambridge University Press:  14 April 2015

Asad Latif ,
Bernadette Kelly ,
Hanan Edrees ,
Paula S. Kent ,
Sallie J. Weaver ,
Branislava Jovanovic ,
Hadeel Attallah ,
Kristin K. de Grouchy ,
Ali Al-Obaidli  and
Christine A. Goeschel
...Show all authors
Asad Latif*
Affiliation:
Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Bernadette Kelly
Affiliation:
SEHA (Abu Dhabi Health Services Company), Abu Dhabi, United Arab Emirates
Hanan Edrees
Affiliation:
Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Paula S. Kent
Affiliation:
Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland Johns Hopkins Hospital, Baltimore, Maryland
Sallie J. Weaver
Affiliation:
Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Branislava Jovanovic
Affiliation:
SEHA (Abu Dhabi Health Services Company), Abu Dhabi, United Arab Emirates
Hadeel Attallah
Affiliation:
SEHA (Abu Dhabi Health Services Company), Abu Dhabi, United Arab Emirates
Kristin K. de Grouchy
Affiliation:
Johns Hopkins Medicine International, Baltimore, Maryland
Ali Al-Obaidli
Affiliation:
SEHA (Abu Dhabi Health Services Company), Abu Dhabi, United Arab Emirates
Christine A. Goeschel
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland MedStar Health, Columbia, Maryland
Sean M. Berenholtz
Affiliation:
Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
*
Address correspondence to Asad Latif, MD, MPH, 600 N. Wolfe St, Meyer 297-A, Baltimore, MD 21287 (alatif1@jhmi.edu).
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Abstract

OBJECTIVE

To determine whether implementation of a multifaceted intervention would significantly reduce the incidence of central line–associated bloodstream infections.

DESIGN

Prospective cohort collaborative.

SETTING AND PARTICIPANTS

Intensive care units of the Abu Dhabi Health Services Company hospitals in the Emirate of Abu Dhabi.

INTERVENTIONS

A bundled intervention consisting of 3 components was implemented as part of the program. It consisted of a multifaceted approach that targeted clinician use of evidence-based infection prevention recommendations, tools that supported the identification of local barriers to these practices, and implementation ideas to help ensure patients received the practices. Comprehensive unit-based safety teams were created to improve safety culture and teamwork. Finally, the measurement and feedback of monthly infection rate data to safety teams, senior leaders, and staff in participating intensive care units was encouraged. The main outcome measure was the quarterly rate of central line–associated bloodstream infections.

RESULTS

Eighteen intensive care units from 7 hospitals in Abu Dhabi implemented the program and achieved an overall 38% reduction in their central line–associated bloodstream infection rate, adjusted at the hospital and unit level. The number of units with a quarterly central line–associated bloodstream infection rate of less than 1 infection per 1,000 catheter-days increased by almost 40% between the baseline and postintervention periods.

CONCLUSION

A significant reduction in the global morbidity and mortality associated with central line–associated bloodstream infections is possible across intensive care units in disparate settings using a multifaceted intervention.

Infect. Control Hosp. Epidemiol. 2015;36(7):816–822

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 7 , July 2015 , pp. 816 - 822
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Allegranzi, B, Bagheri Nejad, S, Combescure, C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377:228–241.Google Scholar
2. Digiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160:976–981.Google Scholar
3. Higuera, F, Rangel-Frausto, MS, Rosenthal, VD, et al. Attributable cost and length of stay for patients with central venous catheter–associated bloodstream infection in Mexico City intensive care units: a prospective, matched analysis. Infect Control Hosp Epidemiol 2007;28:31–35.Google Scholar
4. Rosenthal, VD, Guzman, S, Migone, O, Crnich, CJ. The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: a prospective, matched analysis. Am J Infect Control 2003;31:475–480.Google Scholar
5. Rosenthal, VD. Central line-associated bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis 2009;49:1899–1907.Google Scholar
6. Rosenthal, VD, Bijie, H, Maki, DG, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004–2009. Am J Infect Control 2012;40:396–407.CrossRefGoogle ScholarPubMed
7. World Health Organization. Report on the Burden of Endemic Health Care-Associated Infection Worldwide: A Systematic Review of the Literature. Geneva, Switzerland: World Health Organization, 2011. Available at: http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf.Google Scholar
8. Rosenthal, VD, Maki, DG, Jamulitrat, S, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003–2008, issued June 2009. Am J Infect Control 2010;38:95–104.e2.Google Scholar
9. Pronovost, PJ, Berenholtz, SM, Goeschel, C, et al. Improving patient safety in intensive care units in Michigan. J Crit Care 2008;23:207–221.Google Scholar
10. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.Google Scholar
11. Pronovost, PJ, Goeschel, CA, Colantuoni, E, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010;340:c309.Google Scholar
12. Lipitz-Snyderman, A, Steinwachs, D, Needham, DM, Colantuoni, E, Morlock, LL, Pronovost, PJ. Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis. BMJ 2011;342:d219.Google Scholar
13. Waters, HR, Korn, R Jr, Colantuoni, E, et al. The business case for quality: economic analysis of the Michigan Keystone Patient Safety Program in ICUs. Am J Med Qual 2011;26:333–339.CrossRefGoogle ScholarPubMed
14. Sexton, JB, Berenholtz, SM, Goeschel, CA, et al. Assessing and improving safety climate in a large cohort of intensive care units. Crit Care Med 2011;39:934–939.Google Scholar
15. Berenholtz, SM, Lubomski, LH, Weeks, K, et al. Eliminating central line–associated bloodstream infections: a national patient safety imperative. Infect Control Hosp Epidemiol 2014;35:56–62.Google Scholar
16. Palomar, M, Alvarez-Lerma, F, Riera, A, et al. Impact of a national multimodal intervention to prevent catheter-related bloodstream infection in the ICU: the Spanish experience. Crit Care Med 2013;41:2364–2372.Google Scholar
17. Bion, J, Richardson, A, Hibbert, P, et al. “Matching Michigan”: a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England. BMJ Qual Saf 2013;22:110–123.Google Scholar
18. Mermel, LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000;132:391–402.Google Scholar
19. Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:2014–2020.Google Scholar
20. Gurses, AP, Murphy, DJ, Martinez, EA, Berenholtz, SM, Pronovost, PJ. A practical tool to identify and eliminate barriers to compliance with evidence-based guidelines. Jt Comm J Qual Patient Saf 2009;35:526–532; 485.Google Scholar
21. Agency for Healthcare Research and Quality. Using a comprehensive unit-based safety program to prevent healthcare-associated infections. http://www.ahrq.gov/professionals/quality-patient-safety/cusp/index.html. Published 2012.Google Scholar
22. Barron, WM, Krsek, C, Weber, D, Cerese, J. Critical success factors for performance improvement programs. Jt Comm J Qual Patient Saf 2005;31:220–226.Google Scholar
23. Lubomski, LH, Marsteller, JA, Hsu, YJ, Goeschel, CA, Holzmueller, CG, Pronovost, PJ. The team checkup tool: evaluating QI team activities and giving feedback to senior leaders. Jt Comm J Qual Patient Saf 2008;34:619–623; 561.Google Scholar
24. WHO Patient Safety. Programme action areas. http://www.who.int/patientsafety/about/programmes/en/index.html. Updated 2010.Google Scholar
25. Kanj, S, Kanafani, Z, Sidani, N, Alamuddin, L, Zahreddine, N, Rosenthal, V. International Nosocomial Infection Control Consortium findings of device-associated infections rate in an intensive care unit of a Lebanese university hospital. J Glob Infect Dis 2012;4:15–21.Google Scholar
26. Jaggi, N, Rodrigues, C, Rosenthal, VD, et al. Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India. Int J Infect Dis 2013;17:e1218–e1224.Google Scholar
27. Rasslan, O, Seliem, ZS, Ghazi, IA, et al. Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt: International Nosocomial Infection Control Consortium (INICC) findings. J Infect Public Health 2012;5:394–402.Google Scholar
28. Leblebicioglu, H, Ozturk, R, Rosenthal, VD, et al. Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC). Ann Clin Microbiol Antimicrob 2013;12:10. doi:10.1186/1476-0711-12-10.Google Scholar
29. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) report, data summary for 2010, device-associated module. Am J Infect Control 2011;39:798–816.CrossRefGoogle ScholarPubMed
30. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.Google Scholar
31. Sankaranarayanan, K, Matarelli, S, Parkar, H, Abu Haltem, M. From blame to fair and just culture: a hospital in the Middle East shifts its paradigm. PSQH 2013;July/August:30–35. http://psqh.com/from-blame-to-fair-and-just-culture-a-hospital-in-the-middle-east-shifts-its-paradigm?Google Scholar
32. Sankaranarayanan, K. Getting to zero: correlation between safety culture and infection prevention. AMH 2013. http://www.amhmagazine.com/article.php?article_id=989.Google Scholar
33. Mauger Rothenberg, B, Marbella, A, Pines, E, Chopra, R, Black, ER, Aronson, N. Closing the Quality Gap: Revisiting the State of the Science (Vol. 6: Prevention of Healthcare-Associated Infections). Rockville, MD: Agency for Healthcare Research and Quality, 2012.Google Scholar
34. Pronovost, PJ, Berenholtz, SM, Needham, DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ 2008;337:a1714.Google Scholar
35. Dixon-Woods, M, Bosk, CL, Aveling, EL, Goeschel, CA, Pronovost, PJ. Explaining Michigan: developing an ex post theory of a quality improvement program. Milbank Q 2011;89:167–205.CrossRefGoogle Scholar