title: The long-term effect of bundle care for catheter-related blood stream infection: 5-year follow-up.
abstract: OBJECTIVE
  To address the importance of bundle care for catheter-related infection (CRBSI) on the basis of long-term observation in a catheter-abundant cardiovascular intensive care unit (CVICU).
  
  
  METHODS
  Prospective longitudinal cohort study.
  
  
  METHODS
  CVICU of a tertiary referring medical centre in northern Taiwan.
  
  
  METHODS
  Around 1400 critically ill patients annually for 5 years in the CVICU (from January 2010 to June 2015). CRBSI bundle care has been applied ever since by a multidisciplinary team.
  
  
  METHODS
  CRBSI per 1000 catheter days, bloodstream infection (BSI) per 1000 inpatient days, and catheter utilisation rates.
  
  
  RESULTS
  From January 2010 to June 2015 (22 quarters), there were in total 45 140 inpatient days and 24 163 catheter days, with an overall central venous catheter utilisation rate of 53.5%. The duration of the indwelled catheter was 6.3±1.2 days. The beginning CRBSI rate was 7.0 per 1000 catheter days and was significantly decreased to 0.7 per 1000 catheter days (p<0.001). Regarding the time series, cubic polynomial function depicted the CRBSI decrement most vividly (R2=0.501, p=0.005). In addition, the improvement in overall BSIs (2010 Q1, 4.4 per 1000 inpatient days to 2015 Q2, 0.5 per 1000 inpatient days, p<0.001) significantly correlated with the decrease in CRBSI (r=0.86, p<0.001).
  
  
  CONCLUSIONS
  Through the bundle care, we successfully reduced CRBSIs. After 5 years of follow-up, we observed that the effect of bundle care was stepwise and persistent, as long as we kept working on this integrated project.
authors.affiliation: Cardiovascular Intensive Care Unit, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.|Department of Mechanical Engineering, Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Tauyuan City, Taiwan.
authors.forename: Ho-Tsung
authors.initials: HT
authors.lastname: Hsin
authors.affiliation: Division of Infectious Disease, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Meng-Shiuan
authors.initials: MS
authors.lastname: Hsu
authors.affiliation: Department of Mechanical Engineering, Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Tauyuan City, Taiwan.
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Shieh
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000628:therapy*; D055499:Catheter-Related Infections / Q000628:therapy*; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles; D010348:Patient Care Team / Q000458:organization & administration; D011446:Prospective Studies; D058996:Quality Improvement; D013624:Taiwan; D016896:Treatment Outcome