Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis

• Published in: The Lancet infectious diseases Vol. 16; no. 6; pp. 724 - 734
• Main Authors: Ista, Erwin, Dr, van der Hoven, Ben, MD, Kornelisse, René F, PhD, van der Starre, Cynthia, PhD, Vos, Margreet C, Prof, Boersma, Eric, Prof, Helder, Onno K, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.06.2016; Elsevier Limited
• Subjects: Bacteremia - epidemiology; Bacteremia - prevention & control; Catheter-Related Infections - drug therapy; Catheter-Related Infections - prevention & control; Catheterization, Central Venous - adverse effects; Catheters; Chlorhexidine - chemistry; Clinical medicine; Compliance; Cost control; Critical Illness; Cross Infection - prevention & control; Data analysis; Hand Hygiene; Hospital costs; Hospitals; Humans; Incidence; Infection Control; Infectious Disease; Infectious diseases; Intensive care; Intensive Care Units; Intensive Care Units, Neonatal; Intervention; Intubation; Low income groups; Medical instruments; Meta-analysis; Mortality; Nosocomial infections; Patients; Prevention; Quality control; Studies
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(15)00409-0

Summary Background Central-line-associated bloodstream infections (CLABSIs) are a major problem in intensive care units (ICUs) worldwide. We aimed to quantify the effectiveness of central-line bundles (insertion or maintenance or both) to prevent these infections. Methods We searched Embase, MEDLINE OvidSP, Web-of-Science, and Cochrane Library to identify studies reporting the implementation of central-line bundles in adult ICU, paediatric ICU (PICU), or neonatal ICU (NICU) patients. We searched for studies published between Jan 1, 1990, and June 30, 2015. For the meta-analysis, crude estimates of infections were pooled by use of a DerSimonian and Laird random effect model. The primary outcome was the number of CLABSIs per 1000 catheter-days before and after implementation. Incidence risk ratios (IRRs) were obtained by use of random-effects models. Findings We initially identified 4337 records, and after excluding duplicates and those ineligible, 96 studies met the eligibility criteria, 79 of which contained sufficient information for a meta-analysis. Median CLABSIs incidence were 5·7 per 1000 catheter-days (range 1·2–46·3; IQR 3·1–9·5) on adult ICUs; 5·9 per 1000 catheter-days (range 2·6–31·1; 4·8–9·4) on PICUs; and 8·4 per 1000 catheter-days (range 2·6–24·1; 3·7–16·0) on NICUs. After implementation of central-line bundles the CLABSI incidence ranged from 0 to 19·5 per 1000 catheter-days (median 2·6, IQR 1·2–4·4) in all types of ICUs. In our meta-analysis the incidence of infections decreased significantly from median 6·4 per 1000 catheter-days (IQR 3·8–10·9) to 2·5 per 1000 catheter-days (1·4–4·8) after implementation of bundles (IRR 0·44, 95% CI 0·39–0·50, p<0·0001; I2 =89%). Interpretation Implementation of central-line bundles has the potential to reduce the incidence of CLABSIs. Funding None.