TY - JOUR
T1 - Prevention of hospital infections by intervention and training (PROHIBIT)
T2 - results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections
AU - On behalf of the PROHIBIT consortium
AU - van der Kooi, Tjallie
AU - Sax, Hugo
AU - Pittet, Didier
AU - van Dissel, Jaap
AU - van Benthem, Birgit
AU - Walder, Bernhard
AU - Cartier, Vanessa
AU - Clack, Lauren
AU - de Greeff, Sabine
AU - Wolkewitz, Martin
AU - Hieke, Stefanie
AU - Boshuizen, Hendriek
AU - van de Kassteele, Jan
AU - Van den Abeele, Annemie
AU - Boo, Teck Wee
AU - Diab-Elschahawi, Magda
AU - Dumpis, Uga
AU - Ghita, Camelia
AU - FitzGerald, Susan
AU - Lejko, Tatjana
AU - Leleu, Kris
AU - Martinez, Mercedes Palomar
AU - Paniara, Olga
AU - Patyi, Márta
AU - Schab, Paweł
AU - Raglio, Annibale
AU - Szilágyi, Emese
AU - Ziętkiewicz, Mirosław
AU - Wu, Albert W.
AU - Grundmann, Hajo
AU - Zingg, Walter
N1 - Funding Information:
The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project, funded by the European Commission 7th Framework Programme, aimed to address and analyze the variation of IPC practices in Europe. Through its multiple work packages, PROHIBIT generated an overview of IPC at various levels [4–7], including the present study, with the objective of measuring the effectiveness of two interventions of known efficacy in the prevention of CRBSI in European intensive care units (ICUs) (https://plone.unige.ch/prohibit/publications). The results discussed here have partly been presented before, as abstracts [8–10].
Funding Information:
The PROHIBIT study was funded by the European Commission 7th Framework Programme. The study funder had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript. The study funder was not involved in the decision to submit the paper for publication.
Funding Information:
We thank Sylvie Touveneau, Marie‑Noëlle Chraïti and Benedetta Allegranzi, who devoted themselves to the training of the on‑site investigators and study nurses in the workshops, both at the University Medical Center Groningen and the HUG. We thank Lauren Clack for editing. Our gratitude extends also to the participating centres for collaborating in this study, especially the on‑site investigators and study nurses, physicians, (auxiliary) nurses and other healthcare professionals that responded positively to the challenge to improve their hand hygiene and CVC insertion practices and thus contributed to the increased safety of the patients in their care. Martin Wolkewitz has been funded by the German Research Foundation (Deutsche Forschungsgemein‑ schaft; Grant No WO 1746/1‑1).
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Purpose: To test the effectiveness of a central venous catheter (CVC) insertion strategy and a hand hygiene (HH) improvement strategy to prevent central venous catheter-related bloodstream infections (CRBSI) in European intensive care units (ICUs), measuring both process and outcome indicators. Methods: Adult ICUs from 14 hospitals in 11 European countries participated in this stepped-wedge cluster randomised controlled multicentre intervention study. After a 6 month baseline, three hospitals were randomised to one of three interventions every quarter: (1) CVC insertion strategy (CVCi); (2) HH promotion strategy (HHi); and (3) both interventions combined (COMBi). Primary outcome was prospective CRBSI incidence density. Secondary outcomes were a CVC insertion score and HH compliance. Results: Overall 25,348 patients with 35,831 CVCs were included. CRBSI incidence density decreased from 2.4/1000 CVC-days at baseline to 0.9/1000 (p < 0.0001). When adjusted for patient and CVC characteristics all three interventions significantly reduced CRBSI incidence density. When additionally adjusted for the baseline decreasing trend, the HHi and COMBi arms were still effective. CVC insertion scores and HH compliance increased significantly with all three interventions. Conclusions: This study demonstrates that multimodal prevention strategies aiming at improving CVC insertion practice and HH reduce CRBSI in diverse European ICUs. Compliance explained CRBSI reduction and future quality improvement studies should encourage measuring process indicators.
AB - Purpose: To test the effectiveness of a central venous catheter (CVC) insertion strategy and a hand hygiene (HH) improvement strategy to prevent central venous catheter-related bloodstream infections (CRBSI) in European intensive care units (ICUs), measuring both process and outcome indicators. Methods: Adult ICUs from 14 hospitals in 11 European countries participated in this stepped-wedge cluster randomised controlled multicentre intervention study. After a 6 month baseline, three hospitals were randomised to one of three interventions every quarter: (1) CVC insertion strategy (CVCi); (2) HH promotion strategy (HHi); and (3) both interventions combined (COMBi). Primary outcome was prospective CRBSI incidence density. Secondary outcomes were a CVC insertion score and HH compliance. Results: Overall 25,348 patients with 35,831 CVCs were included. CRBSI incidence density decreased from 2.4/1000 CVC-days at baseline to 0.9/1000 (p < 0.0001). When adjusted for patient and CVC characteristics all three interventions significantly reduced CRBSI incidence density. When additionally adjusted for the baseline decreasing trend, the HHi and COMBi arms were still effective. CVC insertion scores and HH compliance increased significantly with all three interventions. Conclusions: This study demonstrates that multimodal prevention strategies aiming at improving CVC insertion practice and HH reduce CRBSI in diverse European ICUs. Compliance explained CRBSI reduction and future quality improvement studies should encourage measuring process indicators.
KW - Behavioural change
KW - Bundle
KW - Catheter-related bloodstream infection
KW - Europe
KW - Hand hygiene
KW - Multicentre
KW - Multimodal strategy
KW - PROHIBIT
UR - http://www.scopus.com/inward/record.url?scp=85038102267&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85038102267&partnerID=8YFLogxK
U2 - 10.1007/s00134-017-5007-6
DO - 10.1007/s00134-017-5007-6
M3 - Article
C2 - 29248964
AN - SCOPUS:85038102267
VL - 44
SP - 48
EP - 60
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 1
ER -