Adherence to the central line bundle in intensive care: An integrative review

Abstract

Background: Central line-associated bloodstream infections (CLABSI) occurring in intensive care units are associated with increased morbidity and mortality, increased length of hospitalization, and cost of care associated with treating CLABSIs. The Centers for Disease Control and Prevention guidelines and checklist bundle are intended to provide evidence-based recommendations for the prevention of CLABSIs. Despite the promotion of central line bundle policies, wide variability exists in compliance and infection rates in intensive care units.

Objective: To evaluate and synthesize the existing literature on adherence to the central line bundle recommendations for the prevention of CLABSI.

Design: Integrative literature review.

Data sources: CINHAL, PubMed, and SCOPUS databases were searched.

Review methods: Whittmore and Knafl's integrative review method.

Results: A total of 608 articles were identified, 407 articles were screened for topic of interest and adherence to the inclusion criteria, and 19 articles were included in this review. None of the 19 studies addressed adherence to all 14 recommendations of the central line bundle checklist.

Conclusion: This integrative review identified gaps in adherence to the central line bundle. Research is needed to determine the actual adherence to each item in the bundle, and to investigate factors that contribute to nonadherence. To achieve complete compliance with all the bundle items creative and innovative technology is needed.

Keywords: Central line associated bloodstream infection; Central line associated bloodstream infection bundle; Central line related infection; Guideline adherence; Intensive care unit; Practice guideline.