title: Central line insertion bundle: experiences and challenges in an adult ICU.
abstract: BACKGROUND
  Central venous catheters are used frequently in the intensive care unit (ICU). However, there is an associated morbidity, mortality and cost derived from their infectious and mechanical complications. The Scottish Patient Safety Programme (SPSP) has developed a multi faceted care bundle, with the aim of reducing catheter-related blood stream infections.
  
  
  OBJECTIVE
  This paper aims to identify and describe the experience and challenges in implementing the SPSP central line insertion bundle in one adult ICU, in a large inner city teaching hospital.
  
  
  METHODS
  'Plan-Do-Study-Act' cycles, checklists for insertion and a standardized trolley were adopted to implement the central line insertion bundle in clinical practice.
  
  
  CONCLUSIONS
  Improving the reliability of the central line insertion bundle has reduced infections. Key steps in the process were setting clear aims and ensuring staff understand the change process and measurement of results. This is fundamental to the success of any quality improvement process.
authors.affiliation: Critical Care Unit, Glasgow Royal Infirmary, Glasgow, UK. j.mcpeake@clinmed.gla.ac.uk
authors.forename: Joanne
authors.initials: J
authors.lastname: McPeake
authors.forename: Shelia
authors.initials: S
authors.lastname: Cantwell
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Booth
authors.forename: Malcolm
authors.initials: M
authors.lastname: Daniel
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control; D055499:Catheter-Related Infections / Q000382:microbiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D057189:Checklist / Q000706:statistics & numerical data*; D003422:Critical Care / Q000379:methods*; D004203:Disinfection / Q000379:methods; D004282:Documentation / Q000379:methods; D017598:Efficiency, Organizational; D019317:Evidence-Based Medicine; D006786:Hospitals, Urban; D006801:Humans; D007400:Interprofessional Relations; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D061214:Patient Safety / Q000592:standards*; D011300:Preoperative Care / Q000379:methods; D016730:Program Development; D011482:Protective Devices; D058996:Quality Improvement / Q000592:standards*; D015203:Reproducibility of Results; D012606:Scotland