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Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis

Koen Blot (UGent) , Jochen Bergs, Dirk Vogelaers (UGent) , Stijn Blot (UGent) and Dominique Vandijck (UGent)
(2014) CLINICAL INFECTIOUS DISEASES. 59(1). p.96-105
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Abstract
This systematic review and meta-analysis examines the impact of quality improvement interventions on central line-associated bloodstream infections in adult intensive care units. Studies were identified through Medline and manual searches (1995-June 2012). Random-effects meta-analysis obtained pooled odds ratios (ORs) and 95% confidence intervals (CIs). Meta-regression assessed the impact of bundle/checklist interventions and high baseline rates on intervention effect. Forty-one before-after studies identified an infection rate decrease (OR, 0.39 [95% CI,.33-.46]; P <.001). This effect was more pronounced for trials implementing a bundle or checklist approach (P = .03). Furthermore, meta-analysis of 6 interrupted time series studies revealed an infection rate reduction 3 months postintervention (OR, 0.30 [95% CI,.10-.88]; P = .03). There was no difference in infection rates between studies with low or high baseline rates (P = .18). These results suggest that quality improvement interventions contribute to the prevention of central line-associated bloodstream infections. Implementation of care bundles and checklists appears to yield stronger risk reductions.
Keywords
catheter-related bloodstream infection, central line-associated bloodstream infection, quality improvement intervention, meta-analysis, INTENSIVE-CARE-UNIT, CATHETER-RELATED INFECTION, CRITICALLY-ILL PATIENTS, EDUCATION-PROGRAM, NOSOCOMIAL INFECTIONS, IMPACT, STRATEGIES, REDUCTION, MORTALITY, ICU

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Chicago
Blot, Koen, Jochen Bergs, Dirk Vogelaers, Stijn Blot, and Dominique Vandijck. 2014. “Prevention of Central Line-associated Bloodstream Infections Through Quality Improvement Interventions: a Systematic Review and Meta-analysis.” Clinical Infectious Diseases 59 (1): 96–105.
APA
Blot, K., Bergs, J., Vogelaers, D., Blot, S., & Vandijck, D. (2014). Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. CLINICAL INFECTIOUS DISEASES, 59(1), 96–105.
Vancouver
1.
Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D. Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. CLINICAL INFECTIOUS DISEASES. 2014;59(1):96–105.
MLA
Blot, Koen, Jochen Bergs, Dirk Vogelaers, et al. “Prevention of Central Line-associated Bloodstream Infections Through Quality Improvement Interventions: a Systematic Review and Meta-analysis.” CLINICAL INFECTIOUS DISEASES 59.1 (2014): 96–105. Print.
@article{4240026,
  abstract     = {This systematic review and meta-analysis examines the impact of quality improvement interventions on central line-associated bloodstream infections in adult intensive care units. Studies were identified through Medline and manual searches (1995-June 2012). Random-effects meta-analysis obtained pooled odds ratios (ORs) and 95\% confidence intervals (CIs). Meta-regression assessed the impact of bundle/checklist interventions and high baseline rates on intervention effect. Forty-one before-after studies identified an infection rate decrease (OR, 0.39 [95\% CI,.33-.46]; P {\textlangle}.001). This effect was more pronounced for trials implementing a bundle or checklist approach (P = .03). Furthermore, meta-analysis of 6 interrupted time series studies revealed an infection rate reduction 3 months postintervention (OR, 0.30 [95\% CI,.10-.88]; P = .03). There was no difference in infection rates between studies with low or high baseline rates (P = .18). These results suggest that quality improvement interventions contribute to the prevention of central line-associated bloodstream infections. Implementation of care bundles and checklists appears to yield stronger risk reductions.},
  author       = {Blot, Koen and Bergs, Jochen and Vogelaers, Dirk and Blot, Stijn and Vandijck, Dominique},
  issn         = {1058-4838},
  journal      = {CLINICAL INFECTIOUS DISEASES},
  keyword      = {catheter-related bloodstream infection,central line-associated bloodstream infection,quality improvement intervention,meta-analysis,INTENSIVE-CARE-UNIT,CATHETER-RELATED INFECTION,CRITICALLY-ILL PATIENTS,EDUCATION-PROGRAM,NOSOCOMIAL INFECTIONS,IMPACT,STRATEGIES,REDUCTION,MORTALITY,ICU},
  language     = {eng},
  number       = {1},
  pages        = {96--105},
  title        = {Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1093/cid/ciu239},
  volume       = {59},
  year         = {2014},
}

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