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Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation

Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation
Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation
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. 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/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.
1366-5278
1-365
Frampton, Geoff
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Harris, Petra
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Cooper, Keith
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Cooper, Tracey
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Cleland, J
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Jones, Jeremy
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Shepherd, Jonathan
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Clegg, A.
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Graves, N
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Welch, Karen
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Cuthbertson, B.H.
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Frampton, Geoff
26c6163c-3428-45b8-b8b9-92091ff6c69f
Harris, Petra
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Cooper, Keith
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Cooper, Tracey
b214d99f-0a75-4ea4-8024-01cf41901738
Cleland, J
d43e9ce4-9b7a-4bf6-988d-c0153ad3ddb3
Jones, Jeremy
270b303b-6bad-4be7-8ea0-63d0e8015c91
Shepherd, Jonathan
dfbca97a-9307-4eee-bdf7-e27bcb02bc67
Clegg, A.
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Graves, N
2be7c597-cbc5-456c-bee6-3f3c6523c947
Welch, Karen
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Cuthbertson, B.H.
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Frampton, Geoff, Harris, Petra, Cooper, Keith, Cooper, Tracey, Cleland, J, Jones, Jeremy, Shepherd, Jonathan, Clegg, A., Graves, N, Welch, Karen and Cuthbertson, B.H. (2014) Educational interventions for preventing vascular catheter bloodstream infections in critical care: evidence map, systematic review and economic evaluation. Health Technology Assessment, 18 (15), 1-365. (doi:10.3310/hta18150). (PMID:24602781)

Record type: Article

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. 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/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.

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More information

e-pub ahead of print date: February 2014
Published date: 8 March 2014
Organisations: Faculty of Medicine, Faculty of Health Sciences

Identifiers

Local EPrints ID: 363097
URI: http://eprints.soton.ac.uk/id/eprint/363097
ISSN: 1366-5278
PURE UUID: 56b9a413-9e6e-40a8-b3c3-6d89d59dfbcb
ORCID for Geoff Frampton: ORCID iD orcid.org/0000-0003-2005-0497
ORCID for Jonathan Shepherd: ORCID iD orcid.org/0000-0003-1682-4330

Catalogue record

Date deposited: 18 Mar 2014 10:09
Last modified: 18 Feb 2021 16:44

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Contributors

Author: Geoff Frampton ORCID iD
Author: Petra Harris
Author: Keith Cooper
Author: Tracey Cooper
Author: J Cleland
Author: Jeremy Jones
Author: A. Clegg
Author: N Graves
Author: Karen Welch
Author: B.H. Cuthbertson

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