Yonsei Med J.  2018 May;59(3):376-382. 10.3349/ymj.2018.59.3.376.

Effect of Central Line Bundle Compliance on Central Line-Associated Bloodstream Infections

• Lee KH
• Cho NH
• Jeong SJ
• Kim MN
• Han SH
• Song YG

• KMID: 2407860
• DOI: http://doi.org/10.3349/ymj.2018.59.3.376

Abstract

PURPOSE
The present study aimed to evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs) in different departments of the same hospital, including the intensive care unit (ICU) and other departments.
MATERIALS AND METHODS
The four components of the CL bundle were hand hygiene, use of maximal sterile barrier precautions, chlorhexidine use, and selection of an appropriate site for venous access. Compliance of the CL bundle and CLABSIs were measured for every department [emergency room (ER), ICU, general ward (GW), and operating room (OR)]. A total of 1672 patients were included over 3 years (August 2013 through July 2016).
RESULTS
A total of 29 CLABSI episodes (1.73%) were identified, and only 53.7% of the patients completed CL bundles. The performance rates of all components of the CL bundle were 22.3%, 28.5%, 36.5%, and 84.6% for the ER, ICU, GW, and OR, respectively. The highest CLABSI rate was observed in patients of the ICU, for whom all components were not performed perfectly. Conversely, the lowest CLABSI rate was observed for patients of GWs, for whom all components were performed. Among individual components, femoral insertion site [relative risk (RR), 2.26; 95% confidence interval (CI), 1.09-4.68], not using a full body drape (RR, 3.55; 95% CI, 1.44-8.71), and not performing all CL bundle components (RR, 2.79; 95% CI, 1.19-6.54) were significant variables associated with CLABSIs.
CONCLUSION
This study provides direct evidence that completing all CL bundle components perfectly is essential for preventing CLABSIs. Customized education should be provided, according to specific weaknesses of bundle performance.

Keyword

Central venous catheter; catheter-associated infection; central line bundle

MeSH Terms

Catheter-Related Infections
Central Venous Catheters
Chlorhexidine
Compliance*
Education
Hand Hygiene
Humans
Intensive Care Units
Operating Rooms
Patients' Rooms
Chlorhexidine

Figure

• 

  Fig. 1 Performance of each component of the CL bundle by individual department. Bars represent the rates for hand washing, use of chlorhexidine, selection of a non-femoral insertion site, performing all components of MBPs, and performing all components of the CL bundle. The CL bundle consists of four components: hand hygiene, use of MBPs, use of a chlorhexidine skin preparation, and selection of an appropriate site for central venous access. MBP, maximal sterile barrier precaution; CL, central line; ICU, intensive care unit; ER, emergency room; OR, operating room; GW, general ward.

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