Group of nurses consulting.

High compliance with “central line bundle” preventive practices can decrease infection rates in the ICU

  • Patients hospitalized in an intensive care unit (ICU) frequently need a central line – a special type of intravenous catheter surgically implanted into a major vein – for the delivery of fluids, nutrition, and medications.
  • However, central lines are associated with a high risk of bloodstream infections (BSIs), which are very expensive to treat and can lead to disability or death. The Institute for Healthcare Improvement has promoted use of a “central line bundle” of clinical practices to reduce the incidence of BSIs associated with central lines.

For this study, the researchers focused on the use of three of the five elements of the bundle:

  1. maximal barrier precautions to maintain sterility when the line is inserted,
  2. optimal selection of the insertion site to reduce chance of contamination, and
  3. daily review of the need for the central line, with prompt removal once no longer required.

 

  • A survey of 415 ICUs in 250 hospitals across the U.S. found that about half had a written central line bundle policy in place. However, only 45% of these units monitored compliance with this policy. Of these, 38% reported a high (> 95%) compliance rate.
  • Among the 312 ICUs that reported BSI rates, lower rates were achieved only for those that had a bundle policy in place, monitored compliance, and reported high compliance with at least one of the three central line bundle elements studied.
  • The researchers estimate that an ICU moving from non-compliance to high compliance with at least one of these central line bundle elements could achieve a 38% reduction in BSIs. This result has the promise to reduce the risks associated with central lines, thereby lowering health care costs and improving health outcomes.

Citation:

Furuya E. Y., Dick, A., Perencevich, E. N., Pogorzelska, M., Goldmann, D., Stone, P. W. (2011). Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS ONE, 6, 1, e15452. DOI:10.1371/journal.pone.0015452

Grant: R01 NR010107

PI: Patricia Stone, PhD, FAAN
Columbia University School of Nursing