Reduction in central line-associated bloodstream infections by implementation of a postinsertion care bundle.

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) cause substantial morbidity and incur excess costs. The use of a central line insertion bundle has been shown to reduce the incidence of CLABSI. Postinsertion care has been included in some studies of CLABSI, but this has not been studied independently of other interventions.

METHODS: Surveillance for CLABSI was conducted by trained infection preventionists using National Health Safety Network case definitions and device-day measurement methods. During the intervention period, nursing staff used a postinsertion care bundle consisting of daily inspection of the insertion site; site care if the dressing was wet, soiled, or had not been changed for 7 days; documentation of ongoing need for the catheter; proper application of a chlorohexidine gluconate-impregnated sponge at the insertion site; performance of hand hygiene before handling the intravenous system; and application of an alcohol scrub to the infusion hub for 15 seconds before each entry.

RESULTS: During the preintervention period, there were 4415 documented catheter-days and 25 CLABSIs, for an incidence density of 5.7 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 2825 catheter-days and 3 CLABSIs, for an incidence density of 1.1 per 1000 catheter-days. The relative risk for a CLABSI occurring during the postintervention period compared with the preintervention period was 0.19 (95% confidence interval, 0.06-0.63; P = .004).

CONCLUSION: This study demonstrates that implementation of a central venous catheter postinsertion care bundle was associated with a significant reduction in CLABSI in a setting where compliance with the central line insertion bundle was already high.