Major article
Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle

https://doi.org/10.1016/j.ajic.2010.03.007Get rights and content

Background

Central line-associated bloodstream infections (CLABSIs) cause substantial morbidity and incur excess costs. The use of a central line insertion bundle has been shown to reduce the incidence of CLABSI. Postinsertion care has been included in some studies of CLABSI, but this has not been studied independently of other interventions.

Methods

Surveillance for CLABSI was conducted by trained infection preventionists using National Health Safety Network case definitions and device-day measurement methods. During the intervention period, nursing staff used a postinsertion care bundle consisting of daily inspection of the insertion site; site care if the dressing was wet, soiled, or had not been changed for 7 days; documentation of ongoing need for the catheter; proper application of a chlorohexidine gluconate-impregnated sponge at the insertion site; performance of hand hygiene before handling the intravenous system; and application of an alcohol scrub to the infusion hub for 15 seconds before each entry.

Results

During the preintervention period, there were 4415 documented catheter-days and 25 CLABSIs, for an incidence density of 5.7 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 2825 catheter-days and 3 CLABSIs, for an incidence density of 1.1 per 1000 catheter-days. The relative risk for a CLABSI occurring during the postintervention period compared with the preintervention period was 0.19 (95% confidence interval, 0.06-0.63; P = .004).

Conclusion

This study demonstrates that implementation of a central venous catheter postinsertion care bundle was associated with a significant reduction in CLABSI in a setting where compliance with the central line insertion bundle was already high.

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Setting

DVAMC-Denver is a university-affiliated acute care teaching hospital with 5000 admissions and 38,000 patient-days per year. It includes a 10-bed medical intensive care unit (MICU) and a 13-bed surgical intensive care unit (SICU), both with a nurse-to-patient ratio of 1:2. Physician staff members are postgraduate residents and faculty of the University of Colorado at Denver School of Medicine.

Surveillance program

The National Health Safety Network definition of CLABSI was applied (Table 1). The number of patients

Results

Compliance with the CVC insertion bundle was 94% during the preintervention period and 93% during the intervention period. During the preintervention period of October 1, 2006, to September 30, 2008, there were 11,434 patient-days and 4415 documented catheter-days, for a catheter utilization proportion of 0.39. There were 25 CLABSIs, for an incidence density of 5.7 CLABSIs/1000 catheter-days. The mean, median, and interquartile range of the dwell time of catheters associated with bloodstream

Discussion

Our findings demonstrate that implementation of a CVC postinsertion care bundle was associated with a significant reduction in CLABSIs. When surveillance data indicated an ongoing high incidence density of CLABSI despite excellent compliance with the insertion bundle, we reviewed each case for clues to the underlying reason for the problem. We found no commonalities in physician staff, service, admission diagnosis, or pathogen. We noted that the median dwell time between catheter insertion and

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Conflicts of interest: None to report.

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