Central Line Bundle Implementation in US Intensive Care Units and Impact on BSI

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Central Line Bundle Implementation in US Intensive Care Units and Impact on Bloodstream Infections

E. Yoko Furuya1, Andrew Dick2, Eli N. Perencevich3, Monika Pogorzelska4, Donald Goldmann5,6,
Patricia W. Stone7*
1 Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, New York, United States of America, 2 RAND Corporation, Boston,
Massachusetts, United States of America, 3 Department of Internal Medicine, Iowa City VA and University of Iowa Carver College of Medicine, Iowa City, Iowa, United
States of America, 4 Columbia University School of Nursing, New York, New York, United States of America, 5 Institute for Healthcare Improvement, Cambridge,
Massachusetts, United States of America, 6 Children’s Hospital Boston, Boston, Massachusetts, United States of America, 7 Columbia University School of Nursing, New
York, New York, United States of America

Abstract
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.
Methodology/Principal Findings: 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 (b = -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/Significance: 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.


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正在做相关的课题，希望能提高医护人员遵循Bundle的依从性。