PURPOSE: Catheter related blood stream infections (CRBSI) has a reported mortality between 4 and 20%. Central line bundles have been proposed as an intervention to reduce CRBSIs in the ICUs. We report the outcomes of using Central Line Bundles in a medical ICU in an inner city hospital.
METHODS: An evidence-based policy on CVC insertion and removal (Central Line Bundle) was instituted in January 2005 with the sub-clavian vein as the preferred access site (Table 1). All ICU patients from January 2005 to December 2006 who had a CVC insertion were included in the study. Rates of CRBSI and line days were collected prospectively as per CDC guidelines. Data before and after institution of the policy was compared and analyzed.
RESULTS: Between Jan 2005 and Dec 2006, there were a total of 3251 central line days and 8 CRBSI's. This compared to a total of 1857 central line days and 18 CRBSI's in the previous year. CRBSI rate per 1000 line days decreased from 9.6 in 2004 to 2.5 in 2005 and was sustained at 2.4 in 2006. The device utilization rate for 2006 was between 25 to 75 percentile indicating a shorter duration of lines in place. There were no CRBSI's for a consecutive period of 210 days in 2005 and 150 days in 2006.
CONCLUSION: An evidence-based intervention resulted in a 75 percent reduction in rates of CRBSI, which was sustained over a 2 year period.
CLINICAL IMPLICATIONS: The use of central line bundle is associated with a significant decrease in CRBSI with an associated decrease in morbidity and mortality. Sub-clavian access may be the preferred site of insertion in the ICU.
DISCLOSURE: Sindhaghatta Venkatram, No Financial Disclosure Information; No Product/Research Disclosure Information