A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital
Received 20 April 2018
Accepted for publication 22 June 2018
Published 21 August 2018 Volume 2018:14 Pages 1453—1456
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Professor Garry Walsh
Rahul Pathak, Sumalatha Gangina, Falina Jairam, Kimberly Hinton
University of Central Florida School of Medicine and Heart of Florida Regional Medical Center, Davenport, FL, USA
Background: We propose that substituting central lines with midlines can help reduce the total number of central line catheter-days as well as central line-associated bloodstream infections (CLABSIs), thereby reducing the associated costs and the resulting increased length of stay. A midline or vascular access program in a community hospital can bring about these positive changes.
Objectives: Our objective is to evaluate whether the institution of a midline program for vascular access at a community hospital can reduce the number of central line catheter-days and the associated CLABSI rate, incidence, and cost.
Materials and methods: We collected data on the number of central line catheter-days per year starting from 2012. We also collected data on the total number of patient-days during this period and the number of CLABSIs. We started Centers for Disease Control and Prevention (CDC)-based recommendations to help decrease CLABSIs in June 2014; this included the use of the central venous catheters (CVC) insertion bundles and CVC maintenance bundle. Chlorhexidine baths were also given to all patients with central lines. In June 2015, we started a midline program and tracked data till June 2017. We then compared the infection rates during these periods.
Results: We conclude that instituting CDC recommendations to decrease CLABSIs did bring down the CLABSI rate; this decrease was not statistically significant. However, the addition of the midline program to replace central lines whenever possible, combined with universal CDC recommendations, did result in a significant decrease in both the number of central line days per patient-day and the CLABSI rate.
Conclusion: We recommend hospitals to develop a midline program to help reduce the use of central line catheters when possible to reduce the total number of catheter-days and the CLABSI rate associated with them.
Keywords: central line-associated bloodstream infections, midline, venous access, hospital-acquired infections, hospital length of stay, quality of care
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