Using Evidence-Based Care Bundles to Reduce Central Line-Associated Infections in High-Risk Settings.

Area of Science:

• Healthcare quality improvement
• Infection prevention and control
• Patient safety

Background:

• Central line-associated bloodstream infections (CLABSIs) are a significant contributor to healthcare-associated infections.
• High-risk settings, including intensive care units and haemodialysis, are particularly vulnerable.
• Previous interventions have shown variable success in reducing CLABSIs.

Purpose of the Study:

• To decrease the incidence of central line-associated bloodstream infections in both intensive and non-intensive care settings.
• To evaluate the effectiveness of evidence-based care bundles in reducing CLABSIs.
• To assess the sustainability of infection rate reductions over time.

Main Methods:

• A pragmatic action research approach was used to develop and implement evidence-based care bundles.
• Change facilitators were recruited on wards to champion bundle implementation.
• Compliance, ward engagement, and CLABSI rates were monitored pre- and post-intervention.

Main Results:

• A 90% reduction in central line-related infections was observed during the intervention period, sustained for up to two years.
• High adherence to care bundles was achieved across all participating wards.
• Improvements in central line insertion practices, particularly documentation, were sustained, while maintenance and removal practices showed less variability.

Conclusions:

• Evidence-based care bundles are an effective strategy for significantly reducing central line-associated bloodstream infections.
• Sustained reductions in CLABSIs are achievable when clinician adherence to care bundles is high.
• Care bundles demonstrate efficacy in diverse high-risk healthcare settings, including those beyond intensive care units.