A comprehensive care bundle reduces harm in patients with central venous access devices: A pre and post intervention study.

Abstract

Abstract Introduction: Central line-associated bloodstream infections (CLABSIs) and major vascular injuries (MVIs) are serious but preventable complications in patients requiring central venous access devices (CVADs). Aims To determine the effectiveness of a comprehensive care bundle (CCB) in reducing the incidence of CLABSIs and MVI in adult patients with central venous access devices (CVAD) in a major tertiary hospital. Methods A pre- and post-intervention study of 9204 patients admitted to The Canberra Hospital ICU between February 1, 2018, and January 31, 2021, using ICU-CLABSI data reported to the Australia and New Zealand Intensive Care Society (ANZICS) and MVI data from a CVAD audit. A preintervention (February 1, 2018, to January 31, 2020) review of CVAD complications indicated significantly greater CLABSIs and MVI than peer hospitals. Intervention: At the institutional level, we introduced an evidence-based CCB, checklist, policy and education package through literature review and multidisciplinary collaboration addressing system- and operator-focused changes on February 1, 2020. Results The postintervention cohort had a significantly lower CLABSI rate than the preintervention (0.32 vs.1.1 per 1000-line days, 3 incidences per 9283-line days vs. 10 incidences per 9079-line days, P < 0.001) despite significantly higher risk factors in the form of mean CVAD line days (387vs378, P < 0.001), number of patients on mechanical ventilation (1739 Vs. 1687,P = 0.005), immunosuppressive diseases (318 vs.119, P < 0.001), leukaemia (99 Vs. 81, P = 0.038) and hepatic diseases (97 Vs. 71, P = 0.006). No MVI was reported postintervention compared to four in the preintervention cohort. Conclusions CCB therapy decreased the incidence of CLABSIs and MVI in patients in a tertiary ICU.