Reducing infection with catheter care bundles

Catheter-related bloodstream infections (CRBSIs) are a serious threat to patients with a vascular access device, yet many are preventable using evidence-based practices.1-3

Carole Hallam, MSc, BSc, RN, Independent Infection Prevention and Control (IPC) Nurse Consultant and Honorary Member of the Infection Prevention Society in the United Kingdom, reviewed the latest evidence on this topic at BD MACOV@23, a virtual edition of the Multidisciplinary Advanced Course on Vascular Access (MACOVA).

Her session explored the benefits of catheter care bundles and whether or not they could be a useful strategy in preventing and reducing catheter-related infections and complications.

More on this topic: I.V.Paedia—Catheter-related bloodstream infection

Are these bundles effective in reducing CLABSIs?

Ms Hallam presented a variety of scientific studies that evaluate catheter care bundles, concluding that they did indeed reduce central line-associated bloodstream infection (CLABSI) occurrence.2,4 She first reviewed the 2006 Michigan-Keystone Project,5 what she claimed as “one of the earliest and probably one of the most famous uses of care bundles.”

This project found that 103 US critical care units were able to reduce catheter-related bloodstream infection (CRBSI) rates from 7.7 to 1.4 per 1,000 catheter days with the implementation of specific infection-reducing interventions.5

Ms Hallam also presented a more recent study from Gupta et al in 2021, which had similar results: following the implementation of a bundle approach, CLABSIs in an adult coronary intensive care unit dropped from 3.1 to 0.4 infections per 1,000 catheter days.2 They were even able to achieve 757 days without a CLABSI reported.2

More on this topic: Catheter maintenance bundles to help prevent vascular catheter infections

Catheter care bundle best practices

Ms Hallam cited some of the key interventions that should be included in a central vascular access device placement bundle, according to The Infusion Nurses Society’s 2021 Infusion Therapy Standards of Practice, including:6

  • Hand hygiene
  • Skin antisepsis using alcohol-based chlorhexidine
  • Maximal sterile barrier precautions
  • Preference to upper body insertion
  • Adherence to proper technique through use and completion of a standardised checklist by someone other than the device inserter

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  1. Stevens V, Geiger K, Concannon C, et al. Inpatient costs, mortality and 30-day re-admission in patients with central-lin-associated bloodstream infections. Clin Microbiol Infect. 2013 May;20(5):O318-24. DOI: 10.1111/1469-0691.12407.
  2. Gupta P, Thomas M, Patel A, et al. Bundle approach used to achieve zero central line-associated bloodstream infections in an adult coronary intensive care unit. BMJ Open Qual. 2021 Feb;10(1):e001200. DOI: 10.1136/bmjoq-2020-001200.
  3. Loveday HP, Wilson JA, Pratt RJ, et al. Epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. J Hosp Infect. 2014 Jan;86:S1-S70. DOI: 10.1016/S0195-6701(13)60012-2.
  4. Sachan H, Manu J. Effectiveness of Care Bundles to Prevent Central Line Associated Blood Stream Infection (CLABSI) in Patient Admitted in ICU – A Systematic Review. International Journal of Science and Research. 2022 Jan;11(6):1053-1057.
  5. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006 Dec 28;355(26):2725-32. DOI: 10.1056/NEJMoa061115.
  6. Gorski LA, Hadaway L, Hagle ME, et al. Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs. 2021;44(1S Suppl 1):S1-S224. DOI: 10.1097/NAN.00000000000000396.
  7. Ray-Barruel G, Xu H, Marsh N, Cooke M, Rickard CM. Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review. Infect Dis Health. 2019 Aug;24(3):152-168. DOI: 10.1016/j.idh.2019.03.001.
  8. Slyne H, Phillips C, Parkes J. Saving lives audits: do they improve infection prevention and control practice? Journal of Infection Prevention. 2012;13(1):24-27. DOI: 10.1177/1757177411424785.

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