title: The impact of central line insertion bundle on central line-associated bloodstream infection.
abstract: BACKGROUND
  Knowledge about the impact of each central line insertion bundle on central line-associated bloodstream infection (CLABSI) is limited.
  
  
  METHODS
  A quality-improvement intervention, including education, central venous catheter (CVC) insertion bundle, process and outcome surveillance, have been introduced since March 2013. Outcome surveillances, including CLABSI per 1,000 catheter-days, CLABSI per 1,000 inpatient-days, and catheter utilization rates (days of catheter use divided by total inpatient-days), were measured. As a baseline measurement for a comparison, we retrospectively collected data from March 1, 2012 to December 31, 2012.
  
  
  RESULTS
  During this 10-month period, there were a total of 687 CVC insertions, and 627 (91.2%) insertions were performed by intensivists. The rate of CLABSI significantly declined from 1.65 per 1000 catheter-day during the pre-intervention period to 0.65 per 1000 catheter-day post-intervention period (P=0.039). CLABSI more likely developed in subjects in which a maximal sterile barrier was not used compared with subjects in which it was used (P=0.03). Moreover, CVC inserted by non-intensivists were more likely to become infected than CVC inserted by intensivists (P=0.010).
  
  
  CONCLUSIONS
  This multidisciplinary infection control intervention, including a central line insertion care bundle, can effectively reduce the rate of CLABSI. The impact of different care bundle varies, and a maximal sterile barrier precaution during catheter insertion is an essential component of the care line insertion bundle.
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Tang
authors.forename: Hsin-Lan
authors.initials: HL
authors.lastname: Lin
authors.forename: Yu-Hsiu
authors.initials: YH
authors.lastname: Lin
authors.forename: Pak-On
authors.initials: PO
authors.lastname: Leung
authors.forename: Yin-Ching
authors.initials: YC
authors.lastname: Chuang
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan. dtmed141@gmail.com.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology*