Development of best evidence-based practice protocols for central venous catheter placement and maintenance to reduce CLABSI

Abstract

Although evidence-based interventions can reduce the incidence of central line-associated bloodstream infection (CLABSI), there is a large gap between evidence-based interventions and the actual practice of central venous catheter (CVC) care. Evidence-based interventions are needed to reduce the incidence of CLABSI in intensive care units (ICU) in China. Professional association, guidelines, and database websites were searched for data relevant to CLABSI in the adult ICUs from inception to February 2020. Checklists were developed for both CVC placement and maintenance. Based on the Integrated Promoting Action on Research Implementation in Health Services framework, a questionnaire collected the cognition and practice of ICU nursing and medical staff on the CLABSI evidence-based prevention guidelines. From January 2018 to December 2021, ICU CLABSI rates were collected monthly. Ten clinical guidelines were included after the screening and evaluation process and used to develop the best evidence-based protocols for CVC placement and maintenance. The CLABSI rates in 2018, 2019, and 2020 were 2.98‰ (9/3021), 1.83‰ (6/3276), and 1.69‰ (4/2364), respectively. Notably, the CLABSI rate in 2021 was 0.38‰ (1/2607). In other words, the ICU CLABSI rate decreased from 1.69‰ to 0.38‰ after implementation of the new protocols. Additionally, our data suggested that the use of ultrasound-guidance for catheter insertion, chlorhexidine body wash, and the use of a checklist for CVC placement and maintenance were important measures for reducing the CLABSI rate. The evidence-based processes developed for CVC placement and maintenance were effective at reducing the CLABSI rate in the ICU.

Figure 1.

Flowchart of the construction and implementation of best evidence-based practice plan. ICU = intensive care unit.

Figure 2.

Flow diagram of guideline screening and inclusion. CDC = Centers for Disease Control and Prevention, CNKI = XXXXX, CSCCM = Chinese Society of Critical Care Medicine, ESICM = European Society of Intensive Care Medicine, GIN = Guidelines International Network, ISCCM = Indian Society of Intensive Care Medicine, RNAO = Registered Nurses’ Association of Ontario, SCCM = Society of Critical Care Medicine, SIGN = Scottish Intercollegiate Guidelines Network, VIP = XXXX.

Figure 3.

CLABSI rates in the intensive care unit of Longgang Central Hospital from January 2018 to December 2021. CLABSI = central line-associated bloodstream infection.