Impact of the pre CVC care bundle on CLABSI

Abstract

OVERVIEW OF TOPIC: Central venous catheters (CVCs) are essential in modem-day health care practice. However it has been identified that patients with a CVC are at risk for infectious complications including local site infection and in severe cases bacteremia also referred to as central line associated blood stream infections (CLABSI). The impact of the pre eve care bundle as a preventive measure in decreasing the occurrence of such infections will be explored in this dissertation. THE RESEARCH QUESTION: Does the implementation of the pre CVC care bundle in critically ill adult patients requiring a CVC reduce the number of CLABSI as compared to conventional eve care? PICO ELEMENTS: The patient population (P) under investigation is the critically ill adult. The intervention (I) and comparison intervention ( C) of interest is the concept of pre CVC bundle care versus conventional CVC care. The desired outcome (0) is a reduction in the number ofCLABSI. INCLUSION/EXCLUSION CRITERIA: Studies investigating the effectiveness of the pre CVC care bundle in critically ill adults were included. Studies which investigated other issues in relation to the eve bundle such as: the effectiveness of the post insertion eve care bundle, the effectiveness of individual components of the eve care bundle (both pre and post), the cost effectiveness or solely the compliance with the CVC care bundle were excluded from this review. Studies that had a mix of adult and paediatric populations in which the results were not reported separately were excluded. SEARCH OUTCOME: 5 studies were found of which 1 was a collaborative cohort study, 1 cross sectional study and 3 quasi experimental studies which specifically answered the PICO question. QUALITY ASSESSMENT: The Critical Appraisal Skills Programme (CASP) tool and The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) tool was used to critically appraise the identified studies. RESULTS: The studies included in this review demonstrated that the implementation of the pre CVC care bundle is effective in reducing CLABSI in the critically ill adult population. CONCLUSIONS: The pre CVC care bundle should be implemented locally in order to achieve a reduction in CLABSI. The care components of the pre CVC care bundle recommended in this review are: the inclusion of hand hygiene, the use of maximal barrier precautions during eve insertion, the use of chlorhexidine-based skin preparation, optimal catheter site selection and daily review of the catheter with prompt removal of unnecessary lines. RECOMENDATIONS: (1) Implementation of the pre eve care bundle and the development of a hospital wide standardized evidence based protocol and (2) nurses should be encouraged and empowered to intervene (in non emergency situations) if these practices are not being adhered to. KEYWORDS: CENTRAL VENOUS CATHETER, CATHETER-RELATED INFECTION, CARE BUNDLE, CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS, CENTRAL LINE BUNDLE