Implementation of Central Line Bundle Guidelines in Insertion of Central Venous Catheters at a Pediatric Critical Care Unit in Nairobi, Kenya: a best practice implementation project

Abstract

Background Central venous catheters (also known as central lines) are venous catheters placed so that the tip of the catheter lies at or near the heart. A well-established risk associated with central line use is central line associated bloodstream infections . The central line bundle focuses on five main aspects of care which together reduce the risk of central line associated bloodstream infections. This implementation project deals in particular with the implementation of aspects of the central line bundle related to insertion of central venous catheters. Objectives The implementation project aimed to identify the current practice in regards to central line insertion, increase the awareness of healthcare workers of the risks associated with central line insertion – particularly the risk of central line associated bloodstream infections, and thereafter to improve compliance to best practice in the implementation of central lines. Methods This project utilized the audit and feedback model using the Joanna Briggs Institute Practical Application of Clinical Evidence System . Audit criteria were created based on the best available evidence on the topic. Ten of the eleven criteria were audited through observation of the insertion procedure, while the eleventh criterion was audited through a staff questionnaire. Both baseline and follow-up audits were conducted in a six-bed critical care unit for children in Nairobi, Kenya. Results The post-implementation (follow-up) audit showed significant improvement in compliance to best practice guidelines in many of the audit criteria selected. Conclusions In our experience, the use of audit and feedback as an implementation tool has proved effective in changing practice and improving compliance to the best available evidence on insertion of central venous catheters in our Critical Care Unit.