Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit

Abstract

Central line-associated bloodstream infections occur commonly and are a potentially preventable source of morbidity in the critical care setting. The purpose of this study was to find a way to decrease central line-associated bloodstream infections. Data were collected from February 1, 2005, to April 31, 2007, on all patients in the critical care unit who had a central venous catheter placed at New York Methodist Hospital in Brooklyn, which is a community teaching hospital with 628 beds. After 5 months of baseline data collection, a multidisciplinary team created a central line bundle to be used when placing central venous catheters. A bundle is a protocol put in place to ensure that a procedure is performed using the latest evidence-based techniques. In this case, it included maximal barrier precautions, hand washing, skin preparation with ChloraPrep (Enturia, Leawood, Kan), use of a central line cart, and avoidance of femoral lines. All central lines placed from the time of intervention were placed using the bundle provided. The variables included the number of central lines, number of central line days, and development of a line infection. The study period was 24 months, which included 9,938 central line days from a total of 1,395 central venous catheters. The average number of central line-associated bloodstream infections per 1000 catheter days decreased from 5.0 to 0.90 (P < .001) after the bundle intervention was initiated. The implementation of a central line bundle campaign resulted in a significant decrease in line-associated bloodstream infections. Based on our study, we recommend that this protocol be adopted nationwide.