Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections

Abstract

PurposeThe present study aimed to evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs) in different departments of the same hospital, including the intensive care unit (ICU) and other departments.Materials and MethodsThe four components of the CL bundle were hand hygiene, use of maximal sterile barrier precautions, chlorhexidine use, and selection of an appropriate site for venous access. Compliance of the CL bundle and CLABSIs were measured for every department [emergency room (ER), ICU, general ward (GW), and operating room (OR)]. A total of 1672 patients were included over 3 years (August 2013 through July 2016).ResultsA total of 29 CLABSI episodes (1.73%) were identified, and only 53.7% of the patients completed CL bundles. The performance rates of all components of the CL bundle were 22.3%, 28.5%, 36.5%, and 84.6% for the ER, ICU, GW, and OR, respectively. The highest CLABSI rate was observed in patients of the ICU, for whom all components were not performed perfectly. Conversely, the lowest CLABSI rate was observed for patients of GWs, for whom all components were performed. Among individual components, femoral insertion site [relative risk (RR), 2.26; 95% confidence interval (CI), 1.09–4.68], not using a full body drape (RR, 3.55; 95% CI, 1.44–8.71), and not performing all CL bundle components (RR, 2.79; 95% CI, 1.19–6.54) were significant variables associated with CLABSIs.ConclusionThis study provides direct evidence that completing all CL bundle components perfectly is essential for preventing CLABSIs. Customized education should be provided, according to specific weaknesses of bundle performance.

Interventions to reduce unnecessary central venous catheter use to prevent central-line–associated bloodstream infections in adults: A systematic review

“…Data regarding our secondary outcomes were limited. Only 2 studies reported compliance with interventions, and these rates varied from 70% to 84%, which were comparably high, based on previously reported rates of compliance to CLABSI bundles of 53.7%–80% 35 38 Similarly, few studies have focused on noninfectious complications and hospital-related outcomes; more studies are needed to assess these outcomes.…”

“…Only 2 studies reported compliance with interventions, and these rates varied from 70% to 84%, which were comparably high, based on previously reported rates of compliance to CLABSI bundles of 53.7%-80%. [35][36][37][38] Similarly, few studies have focused on noninfectious complications and hospital-related outcomes; more studies are needed to assess these outcomes. Regarding cost, 2 studies employing the USGPIVs program both reported a lower cost compared with CVC use: 2 other kinds of intervention (ie, restriction of CVCs insertion and reminders) are essentially simple and low-cost approaches.…”

Positive effect of care bundles on patients with central venous catheter insertions at a tertiary hospital in Beijing, China

“…Although some studies have shown that CRBSI rates were reduced by partial compliance with the care bundles, 28 , 31 one study revealed that the incidence of CRBSI for cases in which all elements of the care bundles were not perfectly performed was twice as high that for cases in which all elements of the care bundles were perfectly performed. 26 Therefore, physicians and nurses should implement all elements of the care bundles completely and without exception. The catheter insertion site may also affect the incidence of CLABSI; previous studies have revealed that femoral vein catheterization is associated with a higher risk of CRBSI than is subclavian or internal jugular vein catheterization.…”

“…This seems to be supported by previous studies of CLABSIs. [26][27][28] Development of the CVC management process and training of nurses in CRBSI-related knowledge are critical to ensure accurate implementation of other components in care bundles. The trained nurses can provide effective nursing measures and proper advice to patients and reduce the uncertainty and diffidence in dealing with clinical problems.…”

Managing and preventing vascular catheter infections: A position paper of the international society for infectious diseases

“…All aspects of the insertion bundle are likely essential in preventing CLABSIs. Insertion in the femoral area, not using a full body drape, not using all components of the maximal sterile barrier precautions and not performing all components of the bundle, have been identified as factors associated with an increased risk of CLABSI (Lee et al, 2018).…”