A Study of Central Line Associated Blood Stream Infections among Patients on Hemodialysis before and after Implementation of a Catheter Care Bundle

Abstract

Background: Central venous catheters (CVCs) are often used as a vascular access in patients with end stage renal diseases when emergency hemodialysis is required, before maturation of arteriovenous fistula or graft, or when a permanent access becomes non-functioning. The most common complication following insertion of a CVC is infections including exit site infection, tunnel infection, or central line related blood stream infections (CLABSIs). Preventing such complications is crucial in these vulnerable patients and this can be accomplished by strict adherence to infection control guidelines. This study aimed to evaluate the efficacy of implementation of a CVC care bundle composed of best evidence based practices to see whether the rates of CLABSIs rates would decrease. Methods: the study was divided into pre and post intervention phases. The duration of each phase was 6 months during which rates of confirmed CLABSIs per 1000 catheter days as well as the causative microorganisms were recorded. The data were then compared and analyzed to evaluate the intervention. Results: CLABSIs rates decreased from 6.7 in phase 1 to 4.1 in phase 2. The relative risk reduction was 0.39. Conclusions: Implementation of bundles for insertion and maintenance of CVCs can help preventing CRBSIs which is very important to improve patient care.