WHY THIS ARTICLE

This article represents the first contribution in the literature on the positive effect – in terms of CR-BSI reduction – of adopting a bundled approach by a medium-sized hospital.

Abstract

Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.

Background and Purpose

Catheter related blood stream infection (CRBSI) is a major cause of patient morbidity, mortality, and cost. Lower CRBSI rates would decrease inpatient length of stay.

Project

An innovative central line bundle was developed to reduce CRBSI. An innovative combination of focused nursing practice and product technologies were selected for the bundle and implemented through a defined educational program. Data was collected from thirty-two critical care beds: 16 medical/surgical ICU and 16 Trauma-Neuro ICU beds.

Results

From January 2006 thru March 2007 there were Zero occurrences of CRBSI. Over this 15 month period our PICC insertions increased by 103%, and our interventional radiology referral rate decreased to less than 2%.

Implications/Conclusions

A multimodality bundle, combining nursing practice interventions and technology can successfully decrease the incidence of CRBSI. While some of the bundle components have not been widely researched and instead are based on theory or accepted clinical practice, the early outcome provides a basis for additional study and refinement. It also invites research into the various components of the bundle to evaluate the effect each separate practice and product lends to its success.