The Bundle "Plus". (April 2015)

• Record Type: Journal Article
• Authors: Walz, J. Matthias; Ellison, Richard T.; Mack, Deborah A.; Flaherty, Helen M.; McIlwaine, John K.; Whyte, Kathleen G.; Landry, Karen E.; Baker, Stephen P.; Heard, Stephen O.
• Is Part Of: Anesthesia & analgesia. Volume 120:Number 4(2015)
• Publication Date: 2015-04
• Subjects: Anesthesiology -- Periodicals; Anesthesia; Anesthesiology; Analgesia; Analgesics; Anesthesiology -- Periodicals; 617.9605
• DOI: 10.1213/ANE.0b013e3182a8b01b
• Languages: English
• ISSNs: 0003-2999

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>BACKGROUND:</title> <p>Central line–associated bloodstream infections (CLABSIs) have decreased significantly over the last decade. Further reductions in CLABSI rates should be possible. We describe a multidisciplinary approach to the reduction of CLABSIs.</p> </sec> <sec> <title>METHODS:</title> <p>This was an observational study of critically ill patients requiring central venous catheters in 8 intensive care units in a tertiary medical center. We implemented a catheter bundle that included hand hygiene, education of providers, chlorhexidine skin preparation, use of maximum barrier precautions, a dedicated line cart, checklist, avoidance of the femoral vein for catheter insertion, chlorhexidine-impregnated dressings, use of anti-infective catheters, and daily consideration of the need for the catheter. Additional measures included root cause analyses of all CLABSIs, creation of a best practice atlas for internal jugular catheters, and enhanced education on blood culture collection. Data were analyzed using the Poisson test and regression.</p> </sec> <sec> <title>RESULTS:</title> <p>CLABSI, catheter use, and microbiology were tracked from 2004 to 2012. There was a 92% reduction in CLABSIs (95% lower confidence limit: 67.4% reduction, <italic>P</italic> < 0.0001). Central venous catheter use decreased significantly from 2008 to 2012 (<italic>P</italic> = 0.032, −151 catheters per year, 95% confidence limits: −277 to −25), whereas peripherally inserted central catheter use increased (<italic>P</italic> = 0.005, 89 catheters per year, 95% confidence limits: 50 to 127). There was no apparent association between unit-specific Acute Physiology And Chronic Health Evaluation III/IV scores and CLABSI. Three units have not had a CLABSI in more than a year. The most common organism isolated was coagulase-negative staphylococcus. Since the implementation of minocycline/rifampin catheters, no cases of methicillin-resistant <italic>Staphylococcus aureus</italic> CLABSI have occurred.</p> </sec> <sec> <title>CONCLUSIONS:</title> <p>The implementation of a standard catheter bundle combined with chlorhexidine dressings, minocycline/rifampin catheters, and other behavioral changes was associated with a sustained reduction in CLABSIs.</p> </sec> </abstract>