EVBP
CONSORT
1a: Title: Preventive strategies for the reduction of central line –associated bloodstream infections in adult intensive care units: A systematic review.
1b. Abstract: Central line associated blood stream infections (CLABSI) are the most frequent cause of infection in healthcare. These infections are significant in the increase of morbidity, mortality, length of hospital stay and healthcare cost. This systematic review show that CLABSI rate can be reduced and/or preventable by implementation of preventive measures. This systematic review included 15 studies published from January 2016 to June 2020. Evidence-based findings showed that interventions to reduce CLABSIs were CL care bundle, use of silver-plated dressings, mandatory report of CLABSI, and constants education of ICU staff, and regular real-time bedside monitoring. Evidence-based also showed that a zero CLABSI rate could be achieved with the use of positive displacement of needleless connectors.
Introduction
2a. Background: Adult patients have the need for central lines while admitted to ICUs due to the complexity of treatment protocols but this benefit increases their risks for bloodstream infections.
2b. Objectives: Aimed towards identification of all existing evidence-base interventions to reduce and/or decrease CLABSIs in adult ICUs
Methods
3a. Trial Design: Systematic Review and Meta-Analyses (PRISMA) guidelines. Randomised controlled trials were excluded because they did not comply with inclusion criteria.
3b. Changes to trial design: N/A
4a. Participation: Databases of Web of Science, CINAHL Plus with full text, MEDLINE Complete, Scopus, and Science Direct
4b. Study settings: Adult ICU
5. Interventions: Systematic review to assess of all existing studies regarding preventive interventions to reduce CLABSIs in adult ICUs from 2016 to 2020. Interventions were divided in 4 groups: CL care bundle, chlorhexidine and silver-plated dressing effectiveness, infection control and multidisciplinary interventions, and mandatory reporting laws on healthcare-associated infections.
6a. Outcome: Analysis of evidence-based CLABSI preventive measures were categorized in all 15 studies. Critical appraisal related to each study was utilized and this systematic review added current evidence-based interventions on the reduction of CLABSIs in adult ICUs. This systematic review aimed to assess all existing studies regarding preventive interventions to reduce CLABSIs in adult ICUs from 2016 to 2020.
6b. Changes to outcomes: Studies removed from initial outcome were studies not published in the English language, nonacademic studies, conference abstracts, oral presentations, studies with no clear description of the interventions applied, studies with unclear aims, methodologies, data collection processes, or missing data; studies conducted wholly or in part with pediatric and other hospital units where the results were not reported separated, and studies conducted together with other healthcare-associated infections where the results were not reported separated.
7a. Sample size: 158 studies initially, 17 were duplicate, thus they were removed. Further screening was done and 117 were excluded for several reasons. The final count after all exclusion was 15 studies.
7b. Interim analyses and stopping guidelines: N/A
8a. Randomisation: sequence generation: N/A
8b: Randomisation: type: N/A
9. Randomisation: Allocation concealment mechanism: N/A
10. Randomisation: Implementation :N/A
11a. Binding: N/A
11b. Similarity of interventions
12a. Statistical methods: United States (six studies): Two cohort studies, a cross-sectional study, a review of infection control policy and data, use of Lean methodology and plan-do-study cycles; in Taiwan (four studies): two prospective studies, a surveillance, and before-after studies. Two prospective –observational studies in Germany and India. In Brazil, a prospective-observational, quasi-experimental studies; in Argentina, one before-after prospective surveillance, and two other studies were a meta-analysis and a systematic review of studies published from 2007 to 2015.
12b. Additional analyses: N/A
Results
13a. Participant flow: Amongst the 15 included studies, six revealed that CL care bundle implementation and compliance were effective in reducing CLABSI rates.
13b. Losses and exclusions: N/A
14a. Recruitment: This systematic review was carried out and included studies published from 2016 to 2020
14b. Baseline date: Table 1
16. Numbers analyzed:
17a. Outcomes and estimation:
-CL care bundle: 632 hospital with 984 ICUs rates of compliance to CL bundle policies greater that 95% with 0.96CLASIs per 1000 catheter days
-Chlorhexidine and silver-plated dressing effectiveness: 95 community hospitals with 136 ICUs following use of chlorhexidine bathing revealed CLABSI rate decrease from 2.38 to 1.28 in 7 ICUs
-Infection control and multidisciplinary interventions: General reductions in CLABSIs rates from 2.9 in 2010 to 0.8in 2011, 0.0 in 2012, and finally 0.9 in 2013 in 16-bed ICU. Another study reported reductions in CLABSI rate from 4.2 to 1.8 when using multidisciplinary interventions in a 24-bed liver transplant ICU. Nosocomial Infection rate decreased from 9.60 to 4.10 in 14 ICUs in 11 hospitals
-Mandatory reporting laws on healthcare-associated infections: this study included 475 ICUs in 244 hospitals in 32 states with reported reduced CLABSI rates by 54% from 1.77 to 0.81
17b. Binary outcomes: N/A
18. Ancillary analyses: N/A
19. Harms: N/A
Discussion
20. Limitations: The review excluded articles not written in the English language. The randomizes trials were excluded.
21. Generalisability: This systematic review plays an important role for nurses, nurse students because it demonstrated evidence based for implementation of infection control protocol. Nursing educators can also benefit from this evidence-based analysis because it can be used to establish interventions within the care guidelines to reduce CLABSIs.
22. Interpretation: This systematic review demonstrated that effective measures can be done in order to decrease CLABSIs. Checklist and bundles within the ICUs need to be carried out and their implementation and evaluation need to be monitored. This review shows that CLABSi rate in the ICU can be drastically reduced by implementation of measurable methods of prevention.
Other information
23. Registration
24. Protocol
25. Funding
Alanazi, T. M., Alharbi, K. S., Alrawaili, A. R., & Arishi, A. M. (2020). Preventive strategies for the reduction of central line-associated bloodstream infections in adult intensive care units: A systematic review. Collegian. https://doi.org/10.1016/j.colegn.2020.12.001