The impact of central line insertion bundle on central line-associated bloodstream infection

Abstract

BackgroundKnowledge about the impact of each central line insertion bundle on central line-associated bloodstream infection (CLABSI) is limited.MethodsA quality-improvement intervention, including education, central venous catheter (CVC) insertion bundle, process and outcome surveillance, have been introduced since March 2013. Outcome surveillances, including CLABSI per 1,000 catheter-days, CLABSI per 1,000 inpatient-days, and catheter utilization rates (days of catheter use divided by total inpatient-days), were measured. As a baseline measurement for a comparison, we retrospectively collected data from March 1, 2012 to December 31, 2012.ResultsDuring this 10-month period, there were a total of 687 CVC insertions, and 627 (91.2%) insertions were performed by intensivists. The rate of CLABSI significantly declined from 1.65 per 1000 catheter-day during the pre-intervention period to 0.65 per 1000 catheter-day post-intervention period (P = 0.039). CLABSI more likely developed in subjects in which a maximal sterile barrier was not used compared with subjects in which it was used (P = 0.03). Moreover, CVC inserted by non-intensivists were more likely to become infected than CVC inserted by intensivists (P = 0.010).ConclusionsThis multidisciplinary infection control intervention, including a central line insertion care bundle, can effectively reduce the rate of CLABSI. The impact of different care bundle varies, and a maximal sterile barrier precaution during catheter insertion is an essential component of the care line insertion bundle.

Catheter Related Bloodstream Infections (Crbsi) in Intensive Care Units: A Prospective Study of Its Rate, Microbiological Profile and Associated Factors

“…These findings are in concordance with other similar studies, where total resistance to amikacin and gentamicin was observed resistance among P. aeruginosa isolates in ICUs from other centres by Kaur, et al [5,18]. In the study by Tang, et al [6] Candida species compromised 4 CLABSI cases, and each one was caused by methicillin-resistant Staphylococcus aureus and coagulasenegative Staphylococci. Parameswaran, et al, in their study found MRSA to be responsible for 26.7% CRBSIs and single isolate of A. Baumannii resistant to all the routine drugs [8].…”

“…Additionally, microbial biofilms may pose a public health problem for persons requiring indwelling medical devices [11]. Prevention development of records and multidisciplinary guidelines of care for central venous catheter insertion and maintenance (bundle care), cutaneous antisepsis, maximum sterile barrier, correct use of central venous catheter insertion technique; use of chlorhexidine-impregnated dressings; early catheter removal, use of antimicrobial catheters, and antimicrobial catheter lock solution [6,12]. Relatively few studies from south India have been conducted on central venous catheter associated bloodstream infections.…”

Eliminating Infections in the ICU: CLABSI

“…The effectiveness of maximal barrier precautions in reducing CLABSI has been demonstrated in various studies, both alone and as part of a multimodal approach [42,44,45]. This was recently reaffirmed by Tang et al, who studied the adherence to the components of the central line bundle and concluded that the use of maximal sterile barriers precautions during insertion was associated with a significantly lower CLABSI rate (OR, 0.14 [95 % CI, 0.03-0.71]) [46]. 4.…”

Central Line-associated Bloodstream Infections: A Critical Look at the Role and Research of Quality Improvement Interventions and Strategies

“…One study implemented a central line checklist for the IHI care bundle items and discovered a low compliance with the item 'maximal sterile barrier precautions'. Not surprisingly, the analysis revealed that CLABSI was more likely to develop in patients in whom maximal sterile barrier precautions were not utilized and when central lines were inserted by non-intensivists [31]. Such results provide an indication of areas for improvement through stepwise introduction of new interventions.…”