Qualitative analyses of contributing factors to central line-associated bloodstream infections and catheter-associated urinary tract infections during the COVID-19 pandemic.

BACKGROUND

During the COVID-19 pandemic, central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) increased substantially across US hospitals.

METHODS

We performed qualitative analyses of free-text contributing factors reported in apparent cause analyses (ACAs) of CLABSIs and CAUTIs occurring August 2020-August 2022 within an academic healthcare system in Atlanta, GA. We developed a framework for classifying contributing factors in terms of critical infection prevention tasks as well as issues affecting these tasks.

RESULTS

We reviewed 350 CLABSI ACAs with 602 contributing factors and 240 CAUTI ACAs with 405 contributing factors. The framework comprised 9 CLABSI-specific and 7 CAUTI-specific tasks and 11 issues affecting tasks for both infection types. The tasks most frequently implicated in CLABSIs were patient bathing (29%) and central line dressing maintenance (23%); in CAUTIs, the most frequent tasks were urinary catheter care (37%) and the assessment of catheter necessity (32%). Although these tasks were affected by nearly every issue, documentation gaps and knowledge or skills deficits were particularly prevalent, with the latter being the primary issue for some infrequently reported tasks (eg, drawing blood from central lines and use of bowel management systems).

CONCLUSIONS

This task-issue framework links infection prevention tasks to systemic issues that undermine their performance and may help quality improvement teams monitor trends and design targeted interventions to strengthen CLABSI and CAUTI prevention.