Insertion care bundles reduce catheter-related blood stream infections and length of stay in critically ill adults.

Abstract

Aim Although Central Venous Catheters (CVCs) are vital in the management of a critically ill patient, their use puts patients at a risk of developing catheter related blood stream infections (CRBSis). CRBSis are considered as to be amongst the most dangerous complications within the health care arena, nevertheless, they are highly preventable. The aim of this project is to review and critically appraise the research evidence about the impact a CVC insertion care bundle has on the incidence of CRBSI rates and the length of stay (LOS) of adult patients in a critical care setting. The review will be guided by the following population intervention comparison and outcome (PICO) question: How effective is the introduction of a Central Venous Catheter Insertion Care Bundle, compared with routine care, in reducing the incidence of catheter related blood stream infections and the length of stay in critically ill adult patients requiring central venous catheters? Methods Used A search was done through six electronic databases to retrieve studies assessing the effectiveness of the introduction of eve insertion care bundles in adult intensive care units aiming at the reduction of CRBSIs and length of ICU stay. These included PubMed, CINAHL Plus with Full Text, Academic Search Complete, Cochrane Central Register of Controlled Trials, Cochrane Database for Systematic Reviews and Google Scholar. Searches were limited to randomized controlled trials (RCTs), systematic reviews, and observational cohort and prospective studies published in English between January 2000 and November 2011. No RCTs and systematic reviews addressing the PICO question were retrieved. The search retrieved eight observational cohort studies that investigated the impact of implementing a eve insertion care bundle on in the incidence of CRBSIs and LOS. The Critical Appraisal Skills Programme (CASP) tool for cohort studies was utilized to guide the critical appraisal of these studies.

Main Findings and Conclusions Overall, the appraised studies provide robust and statistically significant evidence that the introduction that a eve insertion care bundle effectively reduces the incidence of eRBSI rates among critically ill adult patients, as well as their length of stay in a critical care unit, leading to a drop in hospital costs. Recommendations and Implications On the basis of these findings, the simple and inexpensive evidence-based practices constituting eve insertion care bundles have already been implemented in several countries and should similarly be introduced to the local critical care setting. Further research that includes RCTs on the topic is needed. Moreover, education to practitioners involved in eve insertion and strategic planning on the implementation process is imperative as the introduction of eve insertion care bundles requires a cultural change in the ICU setting.