Insertion Bundles Research Articles

A study of microbiological profile and its antimicrobial susceptibility patterns related to central line-associated bloodstream infections in respiratory intensive care unit in a tertiary care hospital

Background: Complications associated with central venous catheter central line central line-associated bloodstream infections (CLABSIs). Methods: We prospective by studied the microbiological profile and antimicrobial susceptibility patterns of isolated bacteria from CLABSIs in respiratory intensive care unit at our a tertiary care teaching hospital in Tirupati, Andhra Pradesh. Results: Colonisers were isolated from 110 of the 288 samples without any growth in blood cultures from among 288 samples that were submitted with a clinical suspicion of sepsis from patients with eligible central line. Among these, Staphylococcus aureus was the predominant coloniser. Seventy-four were blood culture positive, of which 36 showed other sources of infection. In our study, CLABSI rate was 12.9/1000 catheterised days. Among these culture positives, predominant isolate was S. aureus, followed by Staphylococcus hominis, Acinetobacter, Klebsiella and Escherichia coli. All the S. aureus strains were sensitive to linezolid, tetracycline and vancomycin. Among Gram-negative organisms, Acinetobacter baumannii and E. coli strains were 100% sensitive to polymyxin B and tigecycline. In our study, we have observed carbapenem resistance in E. coli and A. baumannii, which is alarming. Methicillin-resistant S. aureus accounted for 71.4% of S. aureus CLABSIs. All A. baumannii (n = 6), Klebsiella (n = 4) and E. coli (n = 4) isolates were extended spectrum beta-lactamase producers. Conclusions: Strict implementation of insertion and maintenance bundle care of the central lines is mandatory to prevent colonisation.

Incidence of Device Associated-Healthcare Associated Infections from a Neurosurgical Intensive Care Unit of a Tertiary Care Center: A Retrospective Analysis.

Background:Deviceassociated infections (DAIs) increase the morbidity and mortality in the intensive care unit (ICU). Studies from the neurosurgical ICU in developing countries are sparse.Aims:The aim of this study was to assess the incidence of device-associated healthcare associated infections, pathogens isolated, antibiotic resistance, and mortality in neurosurgical ICU.Settings and Design:A retrospective study was conducted in the neurosurgical ICU of a tertiary care centerMaterials and Methods:This study was done by analyzing data of patients admitted in a neurosurgical ICU with one or more devices during the period from January 2011 to July 2017.Statistical Analysis:Quantitative variables were expressed as mean and standard deviation; qualitative variables were expressed as frequency and percentage.Results:During this period, 6788 patients with devices were admitted in the ICU, and 316 patients developed DAI. Two hundred and forty-eight patients had catheter-associated urinary tract infection (CAUTI), 78 had ventilator-associated pneumonia (VAP), and 53 had central line-associated bloodstream infection (CLABSI). The incidence rate for CAUTI was 17.83, VAP – 16.83, and CLABSI – 4.39 per 1000 device days. The device utilization ratio was highest for urinary catheter – 0.76, followed by central line – 0.66 and ventilator – 0.25. Predominant pathogens were Klebsiella – 90, Escherichia coli – 77, Pseudomonas – 40, Candida – 39, Acinetobacter – 30, and Enterobacter – 21. Carbapenem resistance was found in Acinetobacter (73.4%), Pseudomonas (45%), and Enterobacter (38%). S. aureus isolated in six cases; four being MRSA (66.7%). Multidrug resistance was found in Acinetobacter (80%), Pseudomonas (60%), Enterobacter (52.3%), Klebsiella (42.3%), and E. coli (33.7%). No colistin resistant Gram negative bacilli or vancomycin resistant enterococci were isolated. During this period 124 patients with DAI died, of which 52 patients had sepsis. The crude mortality rate was 1.83%.Conclusion:The DAI with the highest incidence was CAUTI, followed by VAP and CLABSI. With the implementation of insertion bundles and adherence to aseptic precautions, the DAI rate had come down.

Catheter-related infections: A Scandinavian observational study on the impact of a simple hygiene insertion bundle.

Catheter-related infections (CRIs) and catheter-related bloodstream infections (CRBSIs) are among the most frequent hospital acquired infections. CRI/CRBSI studies in Scandinavian cohorts are scarce. The primary aim of this study was to investigate the CRI/CRBSI incidence and the association between potential risk factors, including the introduction of a simple hygiene insertion bundle and CRIs at a large university hospital in Sweden. We retrospectively included all patients aged 12 and above who received a central venous catheter (CVC) or a central dialysis catheter during a 2-year period, 1year before and 1year after the implementation of a simple hygiene insertion bundle. Microbiological data, including catheter tip cultures and blood cultures, were merged with CVC insertion data. A total of 1722 catheter insertions in 1428 patients were included. CRI and CRBSI incidence were 1.86/1000 and 0.62/1000 catheter days, respectively. In a multivariable regression model, the implementation of a simple hygiene insertion bundle was the independent factor most strongly associated with significantly lower CRI-incidence (95% confidence interval [CI] of odds ratio [OR] 0.23-0.92, P=.029). Choosing multiple lumen catheters was associated with increasing CRI-incidence (95% CI of OR 1.11-2.39, P=.013). The incidence of catheter-related infections and catheter-related bloodstream infections in this Scandinavian cohort was low. The implementation of a simple hygiene insertion bundle seems to be an effective intervention for reducing catheter-related infections. The use of multiple-lumen catheters is associated with increased risk of catheter-related infections.

Putting the Cap on Central Line–Acquired Bloodstream Infections

Our quest for zero central line–acquired bloodstream infections (CLABSIs) began in the fall of 2017. Using the model for improvement from the Institute of Healthcare Improvement helped navigate our initial goal to reduce the CLABSI rate from 2/1,000 catheter days to 1/1,000 catheter days. This nurse-led CLABSI project was designed to address two key drivers: (a) Create a culture of accountability and safety and (b) increase communication, understanding, and use of the CLABSI insertion and maintenance bundles. Setting small, attainable goals stimulated staff nurses’ passions to achieve success. The NICU CLABSI quality improvement team included bedside nurses, the NICU nursing director, medical providers, and NICU peripherally inserted central catheter (PICC) team nurses. Interventions to decrease risk of CLABSI included adherence to standardized practices for central line care while systematically introducing standardized CLABSI insertion and maintenance bundles. Staff audits, readiness rounds, electronic medical record changes, and peer-to-peer audits ensured improved nursing knowledge of central lines. A data board aided in staff and family communication and created transparency of our quality improvement work. Data were collected in standardized format according to Centers for Disease Control and Prevention criteria and compared with historical NICU CLABSI rates. Our CLABSI rate decreased by 50% from September 2017 through August 2018. We are currently 345 days without a CLABSI in our NICU. Using key drivers, with each tied to multiple interventions and tested using plan–do–study–act cycles, made our work meaningful. The meticulous attention to CLABSI bundle processes and audits of each measure assured a reliable level of hardwiring changes; in addition, these interventions yielded a dramatic effect on nursing staff accountability. Our clinical standards focused on insertion as well as maintenance bundle elements, using highly reliable methods. Tools such as visual reminders of bundle elements, line-necessity discussions led by nurses, and daily nursing and multidisciplinary huddles to ensure nurse accountability consistently yielded greater than 95% reliability of implementation of each bundle element.

Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review.

Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral intravenous catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events. In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000-December 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral intravenous catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist. Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2-7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an increase in phlebitis rate. Methodological quality of all studies ranked between 'low' and 'fair'. The effect of PIVC bundles on PIVC complications and bloodstream infection rates remains uncertain. Standardisation of bundle components and more rigorous studies are needed. PROSPERO registration number: CRD42017075142.

Anatomical predictors of conduction damage after transcatheter implantation of the aortic valve

ObjectiveConduction damage following transcatheter aortic valve implantation (TAVI) remains common. Anatomical risk factors remain elusive. We assessed the impact of variability in the dimensions of the membranous septum and position...

Implementation of a paediatric peripheral intravenous catheter care bundle: A quality improvement initiative.

To improve paediatric peripheral intravenous catheter (PIVC) care through the implementation of care bundles. A pre-post study using mixed methods (clinical audit, staff survey, parent interviews) in 2016 at a tertiary paediatric hospital in Brisbane was conducted to evaluate the effectiveness of a PIVC insertion and maintenance bundle to improve PIVC insertion, promote function and support practice. Participants included children with PIVC, parents and staff inserting and managing PIVCs. A mnemonic care bundle, SUCCESS PIVCS (At insertion: Skills, Understand and prepare, Consent, Clean site, Escalate, Secure, Sign and document. During management: Prompt removal, Inspect hourly, Vein patency, Clean hands and Scrub the hub), was developed and implemented via visual aids, workshops and change champions. During audit, PIVC first-attempt insertion success, PIVC failure, PIVC dwell, escalation to senior clinicians and insertion and management procedures were measured. Pre-implementation audit (n = 102) and survey (n = 117) data described high rates of PIVC failure (n = 50; 49%), difficulty obtaining equipment (n = 64; 55%) and pressure to insert (n = 50; 43%). Parent interviews (n = 15) identified lack of communication, fear, appreciation of skilled technicians and technology and care giver roles as key to improving the experience. After implementation first-attempt insertion success (45 vs. 62%; risk ratio 1.37, 95% confidence interval 1.05-1.78), first-attempt escalation to senior clinicians (junior doctor 72 vs. 41%; P = <0.001) and median PIVC dwell (40 vs. 52 h; P = 0.021) improved. This multi-level care bundle demonstrated improvements in the insertion and management of PIVCs; however, PIVC failure remained high.

CRITICAL CARE NURSES' KNOWLEDGE AND PRACTICES REGARDING CENTRAL VENOUS LINE CARE BUNDLE AT EMERGENCY HOSPITAL, MANSOURA UNIVERSITY

Background: Central venous catheter (CVC) represents one of the intravascular access devices that are necessary for critically ill patients. However, it is associated with several risks, of these are central line associated bloodstream infections (CLABSIs) which are serious but often preventable when evidence-based guidelines such as central line bundle are followed. Aim of the study: To assess nurses' knowledge, and practices about central line care bundle at an Emergency Hospital, Mansoura University. Research design: A design was descriptive exploratory. Sample: A convenience sample consisting of 64 nurses was included. Tools of data collection: Data were collected through two tools: critical care nurses' knowledge assessment questionnaire and nurses' practice observational checklist. Results: The great majority of nurses had unsatisfactory knowledge and practices regarding central line care bundle in percentages of 85% & 89.7% respectively. Unsatisfactory knowledge was found in relation to central line associated blood stream infection and central line bundle in percentages of 87.9% & 74.1% respectively. Unsatisfactory practice was found regarding utilization of insertion and maintenance bundle in percentages of 91.4% & 89.7% respectively. Conclusion: nurses had unsatisfactory knowledge and practice. Recommendations: Enhancement of nurses' knowledge and practices regarding central line care bundle through carrying out training programs and ntitepeper of this study on a larger sample.

CRITICAL CARE NURSES' KNOWLEDGE AND PRACTICES REGARDING CENTRAL VENOUS LINE CARE BUNDLE AT EMERGENCY HOSPITAL, MANSOURA UNIVERSITY

Background: Central venous catheter (CVC) represents one of the intravascular access devices that are necessary for critically ill patients. However, it is associated with several risks, of these are central line associated bloodstream infections (CLABSIs) which are serious but often preventable when evidence-based guidelines such as central line bundle are followed. Aim of the study: To assess nurses' knowledge, and practices about central line care bundle at an Emergency Hospital, Mansoura University. Research design: A design was descriptive exploratory. Sample: A convenience sample consisting of 64 nurses was included. Tools of data collection: Data were collected through two tools: critical care nurses' knowledge assessment questionnaire and nurses' practice observational checklist. Results: The great majority of nurses had unsatisfactory knowledge and practices regarding central line care bundle in percentages of 85% & 89.7% respectively. Unsatisfactory knowledge was found in relation to central line associated blood stream infection and central line bundle in percentages of 87.9% & 74.1% respectively. Unsatisfactory practice was found regarding utilization of insertion and maintenance bundle in percentages of 91.4% & 89.7% respectively. Conclusion: nurses had unsatisfactory knowledge and practice. Recommendations: Enhancement of nurses' knowledge and practices regarding central line care bundle through carrying out training programs and repetition of this study on a larger sample.

Can the implementation of a PIVC bundle reduce bloodstream infection? A systematic review

Introduction: A 5-item bundle has been shown to lower central line-associated bloodstream infection (CLABSI) rates in adult intensive care units. However, the impact of peripheral intravenous catheter (PIVC) insertion and maintenance bundles in the general hospital population is unclear.

Changes in health care-associated infection prevention practices in Japan: Results from 2 national surveys

A national survey conducted in 2012 revealed that the rates of regular use of many evidence-based practices to prevent device-associated infections were low in Japanese hospitals. We conducted a second survey 4 years later to evaluate changes in infection prevention practices. Between July 2016 and January 2017, the instrument used in a survey of Japanese hospitals in 2012 was sent to 1,456 Japanese hospitals. The survey assessed general hospital and infection prevention program characteristics and use of practices specific to preventing catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). Independent sample chi-square tests were used to compare prevention practice rates between the first and second surveys. A total of 685/971 (71%) and 940/1,456 (65%) hospitals responded to the first and second surveys, respectively. For CAUTI, only use of bladder ultrasound scanners (11.1%-18.1%; P < .001) increased. For CLABSI, use of chlorhexidine gluconate for insertion site antisepsis (18.5%-41.1%; P < .001), antimicrobial dressing with chlorhexidine (3.4%-7.1%; P = .001), and central line insertion bundle (22.9%-33.0%; P < .001) increased. For VAP, use of semirecumbent positioning of patients (65.0%-72.3%; P = .002), sedation vacation (31.5%-41.6%; P < .001), oscillating/kinetic beds (4.7%-8.6%; P = .002), and a collective VAP prevention bundle (24.8%-34.8%; P < .001) increased. Fewer than 50% of Japanese hospitals reported conducting CAUTI and VAP surveillance. Collaborative approaches and stronger incentives promoting infection prevention efforts may be warranted to further increase use of most evidence-based practices to reduce common health care-associated infections in Japan.

A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital.

BackgroundWe propose that substituting central lines with midlines can help reduce the total number of central line catheter-days as well as central line-associated bloodstream infections (CLABSIs), thereby reducing the associated costs and the resulting increased length of stay. A midline or vascular access program in a community hospital can bring about these positive changes.ObjectivesOur objective is to evaluate whether the institution of a midline program for vascular access at a community hospital can reduce the number of central line catheter-days and the associated CLABSI rate, incidence, and cost.Materials and methodsWe collected data on the number of central line catheter-days per year starting from 2012. We also collected data on the total number of patient-days during this period and the number of CLABSIs. We started Centers for Disease Control and Prevention (CDC)-based recommendations to help decrease CLABSIs in June 2014; this included the use of the central venous catheters (CVC) insertion bundles and CVC maintenance bundle. Chlorhexidine baths were also given to all patients with central lines. In June 2015, we started a midline program and tracked data till June 2017. We then compared the infection rates during these periods.ResultsWe conclude that instituting CDC recommendations to decrease CLABSIs did bring down the CLABSI rate; this decrease was not statistically significant. However, the addition of the midline program to replace central lines whenever possible, combined with universal CDC recommendations, did result in a significant decrease in both the number of central line days per patient-day and the CLABSI rate.ConclusionWe recommend hospitals to develop a midline program to help reduce the use of central line catheters when possible to reduce the total number of catheter-days and the CLABSI rate associated with them.

Trends in late-onset sepsis in a neonatal intensive care unit following implementation of infection control bundle: A 15-year audit.

Late-onset sepsis (LOS) is a frequent and important cause of morbidity and mortality in newborn infants admitted to neonatal intensive care units (NICUs). The objective of this study is to evaluate the impact of various infection control quality measures introduced as a bundle on the trends of the LOS in a NICU. This was a prospective quality improvement study involving all neonates admitted to a NICU over a 15-year period between 2002 and 2016. The main focus areas of the bundle included collaborative team effort, hand hygiene, education, central line insertion and maintenance bundles and parenteral nutrition. The main outcome measures were LOS and central line-associated bloodstream infections. Yearly admissions increased during study period, from 776 in 2002 to 952 in 2016. There was a progressive decrease in LOS rate, from 4.3 to 1.6 per 1000 patient days (B coefficient -0.17, 95% confidence interval -0.25, -0.09; P < 0.001), and the central line-associated bloodstream infection rate dropped from 25 in 2003 to 5 in 2016 per 1000 central line days (B coefficient -1.20, 95% confidence interval -1.84, -0.56; P = 0.001). Hand hygiene compliance rates remained consistent, over 80%. During the study period, coagulase-negative staphylococcus caused 56% and Gram-negative organisms 18% of the total infections. Multifaceted infection control bundle practices with a concerted team effort in the implementation, with continuing education, feedback and reinforcement of best infection control practices, can sustain the gains achieved by infection control for a long period of time.

Candidemia in children: Epidemiology, prevention and management.

Candidemia is the leading cause of invasive fungal infections in hospitalised children. The highest rates of candidemia have been recorded in neonates and infants <1year of age. Candidemia is more frequent in neonates and young infants than in adults, and is associated with better clinical outcomes, but higher inpatient costs. Over the last 10years, a declining trend has been noted in the incidence of paediatric candidemia in the US and elsewhere due to the hospital-wide implementation of central-line insertion and maintenance bundles that emphasise full sterile barrier precautions, chlorhexidine skin preparation during line insertion, meticulous site and tubing care, and daily discussion of catheter necessity. Additional interventions aiming at reducing gut-associated candidemia are required in immunocompromised and critically ill children.

EC-99 - CAUTI Reduction Observed During Development of Nurse Driven Protocol for Foley Catheter Removal

Background: Catheter Associated Urinary Tract Infections (CAUTI) are the most frequent device associated hospital infection. In 2014 our CAUTI rate was 4.4/1000 device days. CAUTI reduction initiatives included compliance with a catheter insertion bundle, custom insertion kits, and alternatives to indwelling catheters. Efforts resulted in a 46% rate reduction over a two year period. CAUTI rate in 2016 was 2.37. In 2017 an 83% reduction was observed during the planning and pilot of a nurse driven protocol for urinary management and Foley removal.

Infection of totally implantable venous access devices: A review of the literature.

Totally implantable venous access devices, or ports, are essential in the therapeutic management of patients who require long-term intermittent intravenous therapy. Totally implantable venous access devices guarantee safe infusion of chemotherapy, blood transfusion, parenteral nutrition, as well as repeated blood samples. Minimizing the need for frequent vascular access, totally implantable venous access devices also improve the patient's quality of life. Nonetheless, totally implantable venous access devices are not free from complications. Among those, infection is the most relevant, affecting patients' morbidity and mortality-both in the hospital or outpatient setting-and increasing healthcare costs. Knowledge of pathogenesis and risk factors of totally implantable venous access device-related infections is crucial to prevent this condition by adopting proper insertion bundles and maintenance bundles based on the best available evidence. Early diagnosis and prompt treatment of infection are of paramount importance. As a totally implantable venous access device-related infection occurs, device removal or a conservative approach should be chosen in treating this complication. For both prevention and therapy, antimicrobial lock is a major matter of controversy and a promising field for future clinical studies. This article reviews current evidences in terms of epidemiology, pathogenesis and risk factors, diagnosis, prevention, and treatment of totally implantable venous access device-related infections.

Assessment of efficacy of aseptic intravenous line insertion and maintenance bundle on reduction of incidence of phlebitis and infiltration in children: A quality improvement study

Background : To assess the efficacy of aseptic Intravenous line insertion and maintenance bundle on minimizing the incidence of phlebitis and infiltration by 50% over a period of 2 months Methods : Aquality improvement study was undertaken in the pediatric emergencyAPC, PGIMER, Chandigarh. Ethical approval was taken from the Institute’s Ethics Committee to conduct the study. A total of 185 children of age more than 28 days and 46 health care personnelwere enrolled in the study. The study selected the PDSA(Plan, Do, Study, and Act) model to do the quality improvement. Pre-assessment phase was conducted from 24th June 2017 to 15th July 2017 to find out current practices including facilitators and barriers related to aseptic IV line insertion and maintenance. Permission from Head of Department and Assistant Nursing Superintendent of Advanced Pediatric Centre was taken to assess practices by covert participation. A total of 105 peripheral IV line were inserted during observation time. Out of that checklist was filled for35 IV cannulation and drug administration and it was found that the score ranged between 21.7%-39.1% and 20%-54.2% respectively. Focused group discussions were conducted with the health care personnel to know the facilitators and barriers related to “Aseptic Intravenous line insertion and maintenance bundle”.On the basis of pre-assessment run chart of findings was made and root-cause analysis was done. With the use of action priority matrix 4 sets of interventions of PDSA were selected based on low efforts and high impact. In PDSA 1 sensitization of health care personnel was done on aseptic IV line insertion and maintenance bundle. Supply of articles like injection trays, sterile gauzes, tourniquets, tagaderm and increase supply of hand rubs, clean gloves was ensured. Whatsapp group of health care personnel of pediatric emergency was also made. Regular reminders were sent in the form of text and videos on techniques to be followed during bundle. HCP’s were also encouraged to function as a QI team; they are also informed about their function and responsibilities in team. In PDSA 2 Infection control nurse was introduced to regularly monitor the practices and suggest remedial measures. Positive reinforcement was given and HCPs were encouraged to follow the bundle. In PDSA 3 Health care personnel were again motivated with the findings of PDSA 1 and PDSA 2 and by giving emotional examples. In PDSA 4Reinforcement of team members and other health care personnel to take over of the responsibilities independently without direct role of investigator. After running all the four PDSA cycles health care personnel were also interviewed for their experiences on use of bundle. The process measures that are checklist for IV line insertion/ maintenance” and “administration of drugs through IV revealed increase in scores and in return the primary outcome measure that is incidence of phlebitis and infiltration was reduced. Though 50% reduction can’t be achieved for primary outcome the improvement revealed that the consistent regular efforts can bring improvement. Conclusion : Sensitization of health care personnel, introduction of infection control nurse, repeated motivation of health care personnel, framing the responsibilities of health care team were successful in achieving efficacy of the”aseptic Intravenous line insertion and maintenance bundle” and reducing the rate of infiltration and phlebitis.

Clinical experience of using chlorhexidine gluconate-impregnated dressings in reducing the central line-associated bloodstream infection rate at a Level 1 trauma centre

Introduction: Central venous catheters are vital in critical care which can be associated with infectious and non-infectious adverse events. Materials and Methods: This case–control study was conducted over 1 year in trauma centre of India. All patients admitted in intensive care units (ICUs) having central line inserted during the study period (November 2013–October 2014) were included as cases. Historical controls with non-antibiotic-impregnated dressings were used as controls (November 2012–October 2013). Standard central line insertion and maintenance checklist was followed. Results: A total of 2034 patients were admitted in ICUs during study period, and the central line-associated bloodstream infection (CLABSI) rate was 2.89/1000 catheter days. During the year 2012–2013, 2100 patients were admitted and CLABSI rate was 3.04/1000 catheter days. The mean central line insertion bundle compliance rate was 76.8% in 2012–2013 and 78.37% in 2013–2014. The compliance with scrubbing the access port was minimum 34% while that with change in dressing was the maximum 79%. Discussion: Since CLABSI rate reduction was not statistically significant, the use of biopatch in our setting could not be justified and its use was not found to be cost-effective. In maintenance bundle, compliance with scrubbing the hub was least only 35%. Thus, the use of effective maintenance bundle parameters could easily reduce CLABSI rate.

Impact of two bundles on central catheter-related bloodstream infection in critically ill patients.

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.

Adherence to central venous catheter insertion bundle in neonatal and pediatric units.

To describe the observed behavior of professionals in two neonatal and pediatric intensive care units regarding the use of central venous catheter insertion bundle, and the clinical and birth profile of neonates and children who received the devices. A quantitative descriptive exploratory study was conducted in two intensive care units of a public hospital in Belo Horizonte with neonates and children, between February and September 2016. The sample consisted of 59 observed implants of central venous catheter. Most patients were male preterm infants, of cesarean delivery and proper weight according to the gestational age. Among all procedures observed, only three followed all recommendations for the central venous catheter insertion bundle. Incorrect techniques were observed while performing surgical antisepsis and inadequate use of chlorhexidine, an antiseptic. The findings highlight the importance of more investment in continuous training of the team on the prevention of bloodstream infection caused by central venous catheter to reduce the number of adverse events related to intravenous therapy.