Reduced Central Line-Associated Bloodstream Infection by Application of Integrated Evidence-Based Care Bundle in Critically Ill Patients

Shiung, Tao-Fen

Tuesday, 1 November 2011: 8:50 AM

Shin-shang Chou, RN, MSN, MBA
Intensive Care Unit, Taipei Veterans General Hospital, Taipei, Taiwan
Shu-Fen Lu, RN, MSN
Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
Tao-Fen Shiung, BS
Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan

Learning Objective 1: The learner will be able to form a evidence-based bundle of central line care to improve the nursing care quality

Learning Objective 2: The learner will be able to learn how to improve the nurses' compliance of evidence-based bundle of central line care

Central venous catheter–associated bloodstream infections (CBI) are frequent causes of morbidity and mortality in intensive care units (ICU). The purpose of this study is to apply an integrated evidence-based care bundle in critically ills for reducing CBI rate. The study was divided into in 2 phases：

Phase I: Follow the evidence-based medicine approach, systematic literature review, critical appraisal and integrate the evidence, the central venous catheter (CVC) clinical guideline was formed; then the expert focus group study approach selected 5 items to form the CVC care bundle, which included hand hygiene, maximum sterile barrier precautions, CVC maintaining, daily inspection of the insertion site and reviewing of the need for CVC. Phase II: A pre-post experimental design study was conducted in a 42-bed medical-surgical ICU in a medical center. There were 74 patients in experimental group and 61 patients in control group. Study interventions include an education program for staffs and implement the care bundles into daily practice. The data collection included patients’ demographic data, CBI risk assessment sheet, and checklist of nurses’ compliance with CVC care bundles. The outcomes indicators were CBI incidence, length of stay in ICU and the compliance rate of nurses. The study results revealed that the experimental group had a lower rate of CBI (6/68 vs. 13/48, p<.05), less days in ICU (15.7 vs. 18.5, p<.05) and less catheter days (7.8 vs. 9.0, p<.05). The compliance rates of hand hygiene (94.6% vs. 50.8%), maximum sterile barrier precautions (98.6% vs. 4.9%), CVC maintaining (98.6% vs.54.1%), and daily inspection of the insertion site and reviewing of the need for CVC (98.0% vs. 68.9%) were all improved significantly. This study results provide a strong evidence for clinicians in preventing CBI rates by application CVC care bundles in critically ills.

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