Different Compliance with Central Line Insertion Bundle between Intensivist and Nonintensivist Staff in Intensive Care Units

Abstract

A study was conducted to investigate the physician factors (intensivists vs. nonintensivists) associated with compliance to a central venous catheter (CVC) insertion bundle for reducing the risk of central line-associated bloodstream infection in the intensive care unit (ICU). Compliance with the CVC insertion bundle (includes hand hygiene, maximal sterile barriers upon insertion, use of chlorhexidine gluconate (CHG) for skin preparation, and avoiding the use of the femoral vein as an access site) was observed at a regional teaching hospital [in Taiwan] between 1 March and 30 October 2013. A total of 456 CVC insertions were observed, of which 413 insertions (90.6%) were done by intensivists and 42 by nonintensivists (26 (5.7%) by cardiologists, 13 (2.8%) by surgeons and 3 (0.7%) by trained residents). The overall compliance for all 4 components of the bundle was 60.7%. The compliance with each component was: 100% for hand hygiene, 78.2% for maximal sterile barrier precaution, 99.8% for the use of CHG, and 73.4% for optimal site selection. The compliance with all 4 components and the selection of the optimal insertion site were significantly higher for intensivists than for nonintensivist staff (63.9 vs. 28.6%, P<0.001; 77.0 vs. 38.1%, P<0.001). However, the compliance rates for the 3 other components were similar in both subgroups. This observational study suggests that adherence to the CVC insertion bundle varied substantially according to physician characteristics. In conclusion, variability of CVC insertion compliance can be observed among different individual physicians.