Central line bundle implementation in US intensive care units and impact on bloodstream infections.

E Yoko Furuya,Monika Pogorzelska,Donald Goldmann,Eli N Perencevich,Andrew Dick,Patricia W Stone,Frank R Deleo

doi:10.1371/journal.pone.0015452

Abstract

BackgroundCentral line-associated bloodstream infections (CLABSI) represent a serious patient safety issue. To prevent these infections, bundled interventions are increasingly recommended. We examine the extent of adoption of Central Line (CL) Bundle elements throughout US intensive care units (ICU) and determine their effectiveness in preventing CLABSIs.Methodology/Principal FindingsIn this cross-sectional study, National Healthcare Safety Network (NHSN) hospitals provided the following: ICU-specific NHSN-reported rates of CLABSI/1,000 central line days; policies and compliance rates regarding bundle components; and other setting characteristics. In 250 hospitals the mean CLABSI rate was 2.1 per 1000 central line days and 49% reported having a written CL Bundle policy. However, of those that monitored compliance, only 38% reported very high compliance with the CL Bundle. Only when an ICU had a policy, monitored compliance, and had ≥95% compliance did CLABSI rates decrease. Complying with any one of three CL Bundle elements resulted in decreased CLABSI rates (β = -1.029, p = 0.015). If an ICU without good bundle compliance achieved high compliance with any one bundle element, we estimated that its CLABSI rate would decrease by 38%.Conclusions/SignificanceIn NHSN hospitals across the US, the CL Bundle is associated with lower infection rates only when compliance is high. Hospitals must target improving bundle implementation and compliance as opposed to simply instituting policies.

Highlights

Healthcare-associated infections (HAIs) are a major source of morbidity and mortality despite often being preventable
We examine the extent of adoption of Central Line (CL) Bundle elements throughout US intensive care units (ICU) and determine their effectiveness in preventing Central line-associated bloodstream infections (CLABSI)
In each model we examined the CL Bundle’s ‘‘cross-over’’ effects by assessing whether compliance with the CL Bundle was associated with lower rates of ventilatorassociated pneumonia (VAP)

Summary

Introduction

Healthcare-associated infections (HAIs) are a major source of morbidity and mortality despite often being preventable. In partnership with other national and scientific organizations, the Institute for Healthcare Improvement (IHI) promoted ‘‘care bundles’’ as part of its effort to improve patient safety.[3] The IHI Central Line (CL) Bundle consists of five interventions: hand hygiene; maximal barrier precautions; chlorhexidine skin antisepsis; optimal catheter site selection, with avoidance of the femoral vein for central venous access in adult patients; and daily review of the line necessity, with prompt removal of unnecessary lines.[4]. This bundle is being widely promoted for implementation across the country. We examine the extent of adoption of Central Line (CL) Bundle elements throughout US intensive care units (ICU) and determine their effectiveness in preventing CLABSIs

Objectives

Results

Conclusion