Abstract
Purpose: Central venous catheterization has become the most important treatment in modern clinical medicine; however, the incidence of central line-associated bloodstream infection (CLABSI) might increase if strict sterile precautions were not followed. Hence, many countries are implementing central venous catheter (CVC) care bundle, which includes hand hygiene, maximal barrier precaution, chlorhexidine skin antisepsis, optimal catheter site selection avoiding femoral site, bundle checklist to supervise catheterization procedure, daily review of line necessity with prompt removal of unnecessary lines. These bundle cares were proved to be effective to significantly reduce the CLABSI incidence. Methods: The study described the processes and results of implementing the CVC care bundle from March 2013 to May 2014 in an 1800 beds medical center in northern Taiwan. The CLABSI was collected and compared between preintervention phase (March 2012eFebruary 2013) and post-intervention phase (March 2013eMay 2014). We organized a special cross-functional team chaired by associate superintendent of the hospital and developed the CVC cart. We also held CVC care bundle educations for all healthcare workers. Audit teams were set and compliance of bundle elements were monitored. Results: After using CVC care bundle elements and equipment, combined with monthly review and weekly audit of the healthcare workers’ compliance, the daily assessment compliance rate rose from 60% to 95% in doctor and maintained 95% and above in nurse. The number of CLABSI dropped from 172 to 137, and the CLABSI incidence rate decreased from 11.47& to 6.88& (p < 0.001). By the result, we can predict that 192 cases were reduced, and about NT$14 million was saved. Conclusions: ImplementingCVCcarebundle isan importantandeffectivemedical practice for patients’ safety. It also significantly reduces the incidence of CLABSI. Therefore, the CVC care bundle is indeed feasible and effective.
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