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Open Access Highly Accessed Research article

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

Hung-Jen Tang12, Hsin-Lan Lin34, Yu-Hsiu Lin5, Pak-On Leung8, Yin-Ching Chuang67 and Chih-Cheng Lai8*

Author Affiliations

1 Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan

2 Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan

3 Department of Nursing, Chi Mei Medical Center, Liouying, Tainan, Taiwan

4 Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan

5 The Committee of Infection Control, Chi Mei Medical Center, Liouying, Tainan, Taiwan

6 Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan

7 Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan

8 Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan

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BMC Infectious Diseases 2014, 14:356  doi:10.1186/1471-2334-14-356

Published: 1 July 2014

Abstract

Background

Knowledge about the impact of each central line insertion bundle on central line-associated bloodstream infection (CLABSI) is limited.

Methods

A 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.

Results

During 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).

Conclusions

This 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.

Keywords:
Central line bundle; Central line-associated bloodstream infection; Intensivist