Maintenance care bundles : reducing central line-associated bloodstream infections in intensive care settings

Abstract

Background: Central line-associated bloodstream infections (CLABSIs) are one of the main causes of healthcare associated infections, and a well-recognised cause of morbidity and mortality. CLABSIs can be prevented with care on insertion and maintenance of CVC. In this dissertation the effect of implementing a maintenance bundle to prevent CLABSI will be studied. Research question: A central venous catheter (CVC) maintenance bundle is made up of a set of evidence-based interventions that are used on patients with CVCs with the aim of reducing CLABSI rates. A PEO question was formed: “Is the implementation of a daily care maintenance bundle effective in reducing central line-associated bloodstream infections in intensive care settings?” PEO elements: (Population) Adults in intensive care units, (Exposure) Central line maintenance bundles (Outcome) – Reduced CLABSI rates. Methods: The key elements of the PEO question were used to identify key terms and further generate alternative terms for the search. Inclusion and exclusion criteria were set up to determine eligible studies. A systematic and meticulous search, was carried out through different electronic databases including, PubMed, EBSCO host, Medline and Google Scholar, as well as through manual search. Critical appraisal tools were used to appraise the retrieved articles. The ethical aspects of the studies were also considered. Results: A total of five articles were identified. These included 1 systematic review and 4 quasi-experimental studies (before-and-after studies). The systematic review showed a reduction in the rate of CLABSI after implementation of the maintenance bundle. Three out of four quasi-experimental studies found statistically significant reduction of CLABSI when maintenance bundles were implemented. The other study found a decrease in CLABSI rates, however, failed to report a significant difference between the groups. Conclusion: In conclusion, these articles showed that the use of a central line maintenance bundle, can reduce CLABSI rates. However, further research is needed on this topic. In addition, further education, needs to be given to healthcare workers that frequently come into contact with CVCs.