Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections

Abstract

Purpose: The present study aimed to evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs) in different departments of the same hospital, including the intensive care unit (ICU) and other departments.

Materials and methods: The four components of the CL bundle were hand hygiene, use of maximal sterile barrier precautions, chlorhexidine use, and selection of an appropriate site for venous access. Compliance of the CL bundle and CLABSIs were measured for every department [emergency room (ER), ICU, general ward (GW), and operating room (OR)]. A total of 1672 patients were included over 3 years (August 2013 through July 2016).

Results: A total of 29 CLABSI episodes (1.73%) were identified, and only 53.7% of the patients completed CL bundles. The performance rates of all components of the CL bundle were 22.3%, 28.5%, 36.5%, and 84.6% for the ER, ICU, GW, and OR, respectively. The highest CLABSI rate was observed in patients of the ICU, for whom all components were not performed perfectly. Conversely, the lowest CLABSI rate was observed for patients of GWs, for whom all components were performed. Among individual components, femoral insertion site [relative risk (RR), 2.26; 95% confidence interval (CI), 1.09-4.68], not using a full body drape (RR, 3.55; 95% CI, 1.44-8.71), and not performing all CL bundle components (RR, 2.79; 95% CI, 1.19-6.54) were significant variables associated with CLABSIs.

Conclusion: This study provides direct evidence that completing all CL bundle components perfectly is essential for preventing CLABSIs. Customized education should be provided, according to specific weaknesses of bundle performance.

Keywords: Central venous catheter; catheter-associated infection; central line bundle.

Fig. 1. Performance of each component of the CL bundle by individual department. Bars represent the rates for hand washing, use of chlorhexidine, selection of a non-femoral insertion site, performing all components of MBPs, and performing all components of the CL bundle. The CL bundle consists of four components: hand hygiene, use of MBPs, use of a chlorhexidine skin preparation, and selection of an appropriate site for central venous access. MBP, maximal sterile barrier precaution; CL, central line; ICU, intensive care unit; ER, emergency room; OR, operating room; GW, general ward.