Orchestrated protocols for treating CLABSI decreases hospitalizations




Hospitals and health centers that participate in orchestrated testing protocols for diagnosis and treatment of central line–associated bloodstream infections (CLABSI) have lower rates of hospital admissions, according to a new study published in Pediatrics.

“The purpose of the SLUG Bug (Standardizing Line Care Under Guideline Recommendations) collaborative was to provide potentially better practice recommendations for neonatal health care professionals in care and maintenance of CVCs [central venous catheters] and to prevent CLABSI [central line–associated bloodstream infections],” wrote Dr. Anthony J. Piazza of the department of pediatrics at Emory University, Atlanta, and his colleagues.

The researchers examined 17 health care centers, from which eight test groups were identified and evaluated via orchestrated testing methods. Each center was surveyed to compare CLABSI rates before and after implementation of SLUG Bug protocols, and to determine each center’s compliance rate on procedural aspects such as tubing change, hub care, and sterilization. The measurable target Dr. Piazza and his colleagues had in mind was to lower CLABSI rates by 15% – deemed “a clinically meaningful target” – over the course of 12 months (Pediatrics. 2016 Dec. 22. doi:10.1542/peds.2014-3642).

The mean CLABSI rate across centers declined from 1.333 per 1,000 line-days at baseline to 1.076 per 1,000 line-days at 12 months, a reduction of 19.28%, meeting the benchmark set by the investigators. Furthermore, all but 1 of the 17 centers included in the study recorded a compliance rate of 75% or higher. Of the eight study groups, only two did not see a reduction in CLABSI rates, with changes of 0.512 and 0.444; all other groups saw CLABSI rates decrease anywhere from –0.157 to –1.860.

“The CLABSI Clinical Practice Recommendation is generalizable to other settings in which prolonged CVC use is medically necessary,” the authors wrote, adding that the “results support strong consideration for the use of sterile [tubing change] in conjunction with [hub care] compliance monitoring to further reduce NICU rates of CLABSI.”

The study did not receive any outside funding. Dr. Piazza did not report any relevant financial disclosures, but several coauthors reported potential conflicts of their own.

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