Central line bundle implementation in US intensive care units and impact on bloodstream infections.
BACKGROUND
Central line-associated bloodstream infections (CLABSI) represent a serious patient safety issue. To prevent these infections, bundled interventions are increasingly recommended. We examine the extent of adoption of Central Line (CL) Bundle elements throughout US intensive care units (ICU) and determine their effectiveness in preventing CLABSIs.


RESULTS
In this cross-sectional study, National Healthcare Safety Network (NHSN) hospitals provided the following: ICU-specific NHSN-reported rates of CLABSI/1,000 central line days; policies and compliance rates regarding bundle components; and other setting characteristics. In 250 hospitals the mean CLABSI rate was 2.1 per 1000 central line days and 49% reported having a written CL Bundle policy. However, of those that monitored compliance, only 38% reported very high compliance with the CL Bundle. Only when an ICU had a policy, monitored compliance, and had ≥ 95% compliance did CLABSI rates decrease. Complying with any one of three CL Bundle elements resulted in decreased CLABSI rates (β = -1.029, p = 0.015). If an ICU without good bundle compliance achieved high compliance with any one bundle element, we estimated that its CLABSI rate would decrease by 38%.


CONCLUSIONS
In NHSN hospitals across the US, the CL Bundle is associated with lower infection rates only when compliance is high. Hospitals must target improving bundle implementation and compliance as opposed to simply instituting policies.
Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, New York, United States of America.
E Yoko
EY
Furuya
Andrew
A
Dick
Eli N
EN
Perencevich
Monika
M
Pogorzelska
Donald
D
Goldmann
Patricia W
PW
Stone
D016470:Bacteremia / Q000517:prevention & control; D017848:Blood-Borne Pathogens; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000382:microbiology; D003430:Cross-Sectional Studies; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units / Q000592:standards*; D014481:United States
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