Table 1:
Use of Practices Designed to Prevent CLABSI or CRBSI in Studies with Economic Evaluations
| Allen 2014 27 | Ander-son 2011 28,72 | Bond 201129 | Burden 2012 30 | Cohen 2010 31 | Cooper 2014 32 | Deutsch 2013 33 | Fraher 2009 34,73,74 | Frankel 2005 35 | Herzer 2014 36,75,76 | Kagan 2014 37 | Kamboj 2015 42 | Kim 2011 38 | Miller 2011 39,77 | Waters 2011/ Dick 2015 40,41 |
|
| Practices Strongly Recommended by AHRQ | |||||||||||||||
| CVC checklists a | I, C | I | I | I, C | -- | I | -- | I, C | -- | I | I, C | I, C | I | I | I |
| Hand hygiene prior to catheter insertion a,b | I, C | I | I | I, C | -- | I | -- | I, C | -- | I | I, C | -- | I | I | I |
| Maximal sterile barrier precautions a,b,c | I, C | I | I | I, C | -- | I | -- | I, C | I, C | I | I, C | -- | I | I | I |
| Chlorhexidine skin anti-sepsis a,b,c | I, C | I | I | I, C | -- | I | -- | I, C | -- | I | I, C | -- | I | I | I |
| Avoidance of femoral and jugular sites a,b | I, C | I | I | I, C | -- | I | -- | I, C | I, C | I | I, C | -- | I | -- d | I |
| Remove non-essential catheters a,b | I, C | I | I | I, C | -- | I | -- | I, C | -- | I | I, C | -- | I | I | I |
| Antimicrobial catheters a,c | I | ||||||||||||||
| Chlorhexidine/silver sulfadiazine | -- | -- | - | -- | -- | -- | -- | -- | I | -- | I, C | -- | -- | -- | -- |
| Minocycline/rifampin | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| All inclusive catheter carts or kits a | I | I | -- | I, C | -- | -- | -- | -- | I | -- | -- | -- | -- | I | -- |
| Disinfect hubs and needleless connectorsa | -- | I | -- | -- | -- | -- | -- | -- | -- | -- | -- | I, C | -- | -- | -- |
| Ultrasound guided placement a,b | -- | - | I | -- | -- | -- | I | -- | -- | -- | -- | -- | I | -- | -- |
| Cover catheter with sterile dressing a,b | I | I | -- | -- | -- | -- | -- | I, C | I | -- | -- | -- | I | I | -- |
| Chlorhexidine spongeaor antimicrobial dressingc | -- | I | -- | -- | -- | -- | -- | -- | -- | -- | -- | I, C | -- | I | -- |
| Education a,b | I | I | I | I, C | I | I | -- | I | I | I | -- | -- | I | I | I |
| Specialized catheter insertion teams a | -- | - | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Other Practices | |||||||||||||||
| Simulation-based training | I | -- | I | I | I | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- |
| Facility-wide surveillance and feedback c | I | I | I | -- | -- | -- | -- | -- | I | -- | -- | -- | I | I | -- |
| Reminders to consider removal | -- | -- | I | I, C | -- | -- | -- | -- | -- | -- | -- | -- | -- | I | -- |
| “Time out” / empowering nurses to stop placement | I | -- | I | I, C | -- | -- | -- | -- | -- | -- | -- | -- | I | I | -- |
| Substitute midline catheter for central line in selected patients | -- | -- | -- | -- | -- | -- | I | -- | -- | -- | -- | -- | -- | -- | -- |
| Reduce frequency of routine catheter changes e | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | I | -- | -- | -- | -- |
| Reduce frequency of routine dressing, tubing, and cap changes | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | I | -- |
| Removal of lines placed in Emergency Department | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | I | -- | -- |
| TPN surveillance by clinical nurse manager | -- | -- | -- | -- | -- | -- | -- | I | -- | -- | -- | -- | -- | -- | -- |
| Six sigma techniques | -- | -- | -- | -- | -- | -- | -- | -- | I | -- | -- | -- | -- | -- | -- |
| Attending supervision of residents | -- | -- | -- | -- | -- | -- | -- | -- | I | -- | -- | -- | -- | -- | -- |
| Specific documentation system | -- | -- | -- | -- | -- | -- | -- | -- | I | -- | -- | -- | -- | -- | -- |
| Disinfectant caps for catheters | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | -- | I | -- | -- | -- |
a
Strongly recommended in AHRQ Report, Making Healthcare Safer II4
b
Recommended by CDC guidelines9
c
Used in at least 25% of hospitals as per national survey69
e
CDC guidelines recommend against routine replacement of central venous catheters9
Abbreviations: CLABSI, central-line-associated bloodstream infection; CVC, central-venous catheter; AHRQ, Agency for Healthcare Research and Quality; I, practice used in intervention scenario; C, practice used in control / usual care scenario; TPN, total parenteral nutrition; CDC, Centers for Disease Control and Prevention