Implementing the Central Line Bundle To Reduce Peripherally Inserted Central Catheter (PICC) Bloodstream Infections

Abstract

PURPOSE: Central venous access devices are vital tools in caring for the many patients. Unfortunately, catheter-related bloodstream infection (CLABSI) is the most frequently occurring nosocomial infection. In 2006 Institute of Health Improvement (IHI) published a bundle of interventions to assist hospitals in reducing the rate of CLBSI. We report the impact of implementing such bundle in the rate of CLABSI in our Spinal Cord Injury Center (SCI). METHODS: We recorded the staff adherence to the IHI bundle that includes: 1) Hand Hygiene, 2) Maximal barrier precautions, 3) Chlorhexidine skin antisepsis, 4) Optimal catheter site selection, with avoidance of using the femoral vein for central venous access in adult patients, and 5) Daily review of line necessity, with prompt removal of unnecessary lines The CLABSI rate was calculated by the standard formula of dividing the number of CLABSIs by the number of central line-days and multiplying the result by 1000. The result represents the CLABSI as number of central line infections/1000 central line-days. RESULTS: The CLABSI rate at our SCI demonstrated a statistically significant decreased between FY07 and FY09 with a standard deviation of 1.6 at 90% confidence. CONCLUSION: Our data demonstrated that the implantation of evidence-based practice guidelines in the care of PICC can be instrumental in preventing CLABSI. Such approach is most successful when all bundles components are executed together. CLINICAL IMPLICATIONS: Implementation of evidence base practice guide lines in the care of PICC can be instrumental in preventing CLABSI.