A Central Line Care Maintenance Bundle for the Prevention of Central Line–Associated Bloodstream Infection in Non–Intensive Care Unit Settings

Abstract

Objective To evaluate a central line care maintenance bundle to reduce central line-associated bloodstream infection (CLABSI) in non-ICU settings. Design Before-after trial with 12 month follow-up period. Setting 1250-bed teaching hospital. Participants Patients with central lines on eight general medicine wards. Four wards received the intervention and four served as controls. Intervention A multifaceted catheter care maintenance bundle consisting of educational programs for nurses, update of hospital policies, visual aids, a competency assessment, process monitoring, regular progress reports, and consolidation of supplies necessary for catheter maintenance. Results Data were collected for 25,542 catheter-days including 43 CLABSI (rate = 1.68 per 1,000 CL-days) and 4,012 catheter dressing observations. Following the intervention, a 2.5% monthly decrease in the CLABSI incidence density was observed on intervention floors, but this was not statistically significant (95% confidence interval (CI); −5.3 – 0.4). On control floors, there was a smaller, but marginally significant decrease in CLABSI incidence during the study (change in monthly rate = −1.1%; 95% CI, −2.1 - −0.1). Implementation of the bundle was associated with improvement in catheter dressing compliance on intervention wards (78.8% compliance pre-intervention vs. 87.9% during intervention/follow-up; p<0.001) but improvement was also observed on control wards (84.9% compliance pre-intervention vs. 90.9% during intervention/follow-up; P = .001). Conclusions A multi-faceted program to improve catheter care was associated with improvement in catheter dressing care, but no change in CLABSI rates. Additional study is needed to determine strategies to prevent CLABSI in non-ICU patients.

Educating intensive care unit nurses to use central venous catheter infection prevention guidelines: effectiveness of an educational course

“…The educational course in this study was successful in expanding nurses’ knowledge of CVC-RI prevention guidelines. This finding is consistent with those of many other studies that indicated the benefits of such courses in the improvement of nurses’ knowledge (Hina and McDowell, 2017; O’Neil et al., 2016). It is also congruent with the recommendations of the Centers for Disease Control and Prevention and the American Thoracic Society for continuing education and training as a basic element in CVC-RI prevention (Labeau et al., 2009; O'Neil et al., 2016).…”

Chlorhexidine gluconate or polyhexamethylene biguanide disc dressing to reduce the incidence of central-line-associated bloodstream infection: a feasibility randomized controlled trial (the CLABSI trial)

“…Our positive CLABSI incidence rate was 2.0% (1.8 per 1000 device days); a rate that is in line with reported rates from other non-ICU cohorts 18 but higher than in centres where there has been a focus on reaching a zero CLABSI rate. 19,20 While the trial was not designed to test for differences, it provides some preliminary data on the efficacy of the two products.…”

Incidence of Central Venous Catheter-Related Bloodstream Infections: Evaluation of Bundle Prevention in Two Intensive Care Units in Central Brazil

“…In the present study, there was a greater proportion of Gram-negative than Gram-positive microorganisms, unlike most studies conducted in North America that show a higher frequency of Gram-positivity in CVC-BSIs [30–32]. However, it corroborates with other studies previously published in several countries and regions [32–35].…”