Educational interventions for preventing vascular catheter bloodstream infections in critical care

evidence map, systematic review and economic evaluation

Geoff K. Frampton*, Petra Harris, Keith Cooper, Tracey Cooper, Jennifer Cleland, Jeremy Jones, Jonathan Shepherd, Andrew Clegg, Nicholas Graves, Karen Welch, Brian H. Cuthbertson

*Corresponding author for this work

Research output: Contribution to journalArticle

16 Citations (Scopus)
4 Downloads (Pure)

Abstract

Background: Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually 19.1-36.2M pound. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking.

Objective: To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England.

Data sources: Sixteen electronic bibliographic databases - including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases - were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references.

Review methods: References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI.

Results: Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly <1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of <5000 pound/quality-adjusted life-year.

Limitations: Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data.

Conclusions: Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.

Original languageEnglish
Article number15
Number of pages367
JournalHealth Technology Assessment
Volume18
DOIs
Publication statusPublished - Feb 2014

Keywords

  • neonatal intensive-care
  • length-of-stay
  • continuous quality-improvement
  • simulation-based education
  • device-related infections
  • central venous catheters
  • targeting hand hygiene
  • nosocomial infections
  • behavioural interventions
  • young-people

Cite this

Educational interventions for preventing vascular catheter bloodstream infections in critical care : evidence map, systematic review and economic evaluation. / Frampton, Geoff K.; Harris, Petra; Cooper, Keith; Cooper, Tracey; Cleland, Jennifer; Jones, Jeremy; Shepherd, Jonathan; Clegg, Andrew; Graves, Nicholas; Welch, Karen; Cuthbertson, Brian H.

In: Health Technology Assessment, Vol. 18, 15, 02.2014.

Research output: Contribution to journalArticle

Frampton, Geoff K. ; Harris, Petra ; Cooper, Keith ; Cooper, Tracey ; Cleland, Jennifer ; Jones, Jeremy ; Shepherd, Jonathan ; Clegg, Andrew ; Graves, Nicholas ; Welch, Karen ; Cuthbertson, Brian H. / Educational interventions for preventing vascular catheter bloodstream infections in critical care : evidence map, systematic review and economic evaluation. In: Health Technology Assessment. 2014 ; Vol. 18.
@article{1525e6bda6c64e74b0ae98ce22aea5d5,
title = "Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation",
abstract = "Background: Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually 19.1-36.2M pound. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking.Objective: To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England.Data sources: Sixteen electronic bibliographic databases - including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases - were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references.Review methods: References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI.Results: Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly <1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of <5000 pound/quality-adjusted life-year.Limitations: Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data.Conclusions: Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.",
keywords = "neonatal intensive-care, length-of-stay, continuous quality-improvement, simulation-based education, device-related infections, central venous catheters, targeting hand hygiene, nosocomial infections, behavioural interventions, young-people",
author = "Frampton, {Geoff K.} and Petra Harris and Keith Cooper and Tracey Cooper and Jennifer Cleland and Jeremy Jones and Jonathan Shepherd and Andrew Clegg and Nicholas Graves and Karen Welch and Cuthbertson, {Brian H.}",
note = "Funding The National Institute for Health Research Health Technology Assessment programme.",
year = "2014",
month = "2",
doi = "10.3310/hta18150",
language = "English",
volume = "18",
journal = "Health Technology Assessment",
issn = "1366-5278",
publisher = "National Co-ordinating Centre for HTA",

}

TY - JOUR

T1 - Educational interventions for preventing vascular catheter bloodstream infections in critical care

T2 - evidence map, systematic review and economic evaluation

AU - Frampton, Geoff K.

AU - Harris, Petra

AU - Cooper, Keith

AU - Cooper, Tracey

AU - Cleland, Jennifer

AU - Jones, Jeremy

AU - Shepherd, Jonathan

AU - Clegg, Andrew

AU - Graves, Nicholas

AU - Welch, Karen

AU - Cuthbertson, Brian H.

N1 - Funding The National Institute for Health Research Health Technology Assessment programme.

PY - 2014/2

Y1 - 2014/2

N2 - Background: Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually 19.1-36.2M pound. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking.Objective: To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England.Data sources: Sixteen electronic bibliographic databases - including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases - were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references.Review methods: References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI.Results: Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly <1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of <5000 pound/quality-adjusted life-year.Limitations: Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data.Conclusions: Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.

AB - Background: Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually 19.1-36.2M pound. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking.Objective: To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England.Data sources: Sixteen electronic bibliographic databases - including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases - were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references.Review methods: References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI.Results: Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly <1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of <5000 pound/quality-adjusted life-year.Limitations: Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data.Conclusions: Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI.

KW - neonatal intensive-care

KW - length-of-stay

KW - continuous quality-improvement

KW - simulation-based education

KW - device-related infections

KW - central venous catheters

KW - targeting hand hygiene

KW - nosocomial infections

KW - behavioural interventions

KW - young-people

U2 - 10.3310/hta18150

DO - 10.3310/hta18150

M3 - Article

VL - 18

JO - Health Technology Assessment

JF - Health Technology Assessment

SN - 1366-5278

M1 - 15

ER -