Abstract
ABSTRACTObjective:To evaluate the impact of the implementation of insertion and maintenance bundles on the rates of catheter-related bloodstream infection in an intensive care unit. Method:This is a quasi-experimental, before-and-after study with a non-equivalent control group. During a six-month period, insertion and maintenance bundles for the central venous catheters were implemented. Supervision guidelines were developed to assess compliance with the bundle and catheter characteristics. Results:A total of 444 central catheters corresponding to 390 patients were observed, of which 68.7% were inserted in the unit. The maintenance and insertion bundles reached 62.9% and 94.7% compliance, respectively, and 50.7% of the insertions were supervised. It was possible to observe a 54.5% decrease in the rate of central catheter infection (3.48 vs 1.52 x 1000 days/catheter, p<0.05) when compared with the control group. Conclusion:The simultaneous implementation of insertion and maintenance bundles has a positive impact on the reduction of catheter-related bloodstream infection; therefore it is an efficient alternative to improve the quality and safety of care in high complexity units.
Highlights
Intensive care units (ICUs) are highly qualified to care and treat patients at risk through invasive therapy, procedures and devices such as the central venous catheter (CVC)
Most of the CVCs assessed were inserted in the medical-surgical ICU (MSICU) (68.7%) and 38.3% were removed while the patient remained in the MSICU
The level of compliance with the maintenance bundle was low compared to other studies . [18,19] A 95% adherence is suggested in order to achieve a substantial reduction in Catheter-related bloodstream infection (CRBSI) rates, which is usually not achieved . [20] The maintenance bundle, on the other hand, reached high compliance levels for each individual measure and included the daily evaluation of the CVC insertion site, a measure that is not frequent, despite its presence in the bundles that led to a decrease in the CRBSI rate . [18,19]
Summary
Intensive care units (ICUs) are highly qualified to care and treat patients at risk through invasive therapy, procedures and devices such as the central venous catheter (CVC). [1,2] Despite its benefits, the CVC can lead to mechanical or infectious complications. The latter are more frequent and have greater impact on the patient . [3,4] Catheter-related bloodstream infection (CRBSI) is a complication that can be related to increases in costs, length of stay and morbidity and mortality rates, especially among ICU patients[5,6,7]. There are several risk factors associated with CRBSI, such as: duration of catheterization, number of lumens, femoral access site, excessive manipulation of the CVC, total parenteral nutrition, bacterial colonization at the insertion site, prolonged hospitalization, and others (1012). Research on CRBSI prevention demonstrated the effectiveness of bundles, which reduce the incidence of CRBSI by up to 80% [5, 6,14] reaching a rate of 0 in some cases[4,15]
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