Implementation of central venouscatheter bundle in an intensive care unitin Kuwait: Effect on centralline-associated bloodstream infections

ABSTRACT

Central line-associated bloodstream infection [CLABSIs] is an importanthealthcare-associated infection in the critical care units. It causes substantial mor-bidity, mortality and incurs high costs. The use of central venous line [CVL] insertionbundle has been shown to decrease the incidence of CLABSIs.Our aim was to study the impact of CVL insertion bundle on incidence of CLABSIand study the causative microbial agents in an intensive care unit in Kuwait.Surveillance for CLABSI was conducted by trained infection control team usingNational Health Safety Network [NHSN] case definitions and device days measure-ment methods. During the intervention period, nursing staff used central line carebundle consisting of [1] hand hygiene by inserter [2] maximal barrier precautionsupon insertion by the physician inserting the catheter and sterile drape from headto toe to the patient [3] use of a 2% chlorohexidine gluconate [CHG] in 70% ethanolscrub for the insertion site [4] optimum catheter site selection. [5] Examination ofthe daily necessity of the central line.During the pre-intervention period, there were 5367 documented catheter-daysand 80 CLABSIs, for an incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 5052 catheter-days and 56CLABSIs, for an incidence density of 11.08 per 1000 catheter-days. The reduction inthe CLABSI/1000 catheter days was not statistically significant [P = 0.0859].This study demonstrates that implementation of a central venous catheter post-insertion care bundle was associated with a reduction in CLABSI in an intensive carearea setting: