Reducing the rate of catheter-associated bloodstream infections in a surgical intensive care unit using the Institute for Healthcare Improvement Central Line Bundle

Am J Surg. 2014 Jun;207(6):817-23. doi: 10.1016/j.amjsurg.2013.08.041. Epub 2014 Jan 2.

Abstract

Background: Central line-associated bloodstream infections (CLABSIs) are a significant source of morbidity and mortality. This study sought to determine whether implementation of the Institute for Healthcare Improvement (IHI) Central Line Bundle would reduce the incidence of CLABSIs.

Methods: The IHI Central Line Bundle was implemented in a surgical intensive care unit. Patient demographics and the rate of CLABSIs per 1,000 catheter days were compared between the pre- and postintervention groups. Contemporaneous infection rates in an adjacent ICU were measured.

Results: Baseline demographics were similar between the pre- and postintervention groups. The rate of CLABSIs per catheter days decreased from 19/3,784 to 3/1,870 after implementation of the IHI Bundle (1.60 vs 5.02 CLABSIs per 1,000 catheter days; rate ratio .32 [.08 to .99, P < .05]). There was no significant change in CLABSIs in the control ICU.

Conclusions: Implementation of the IHI Central Line Bundle reduced the incidence of CLABSIs in our SICU by 68%, preventing 12 CLABSIs, 2.5 deaths, and saving $198,600 annually.

Keywords: Catheter-associated line infections; Central venous catheters; Checklist; Healthcare cost; Infection control; Quality improvement.

MeSH terms

  • APACHE
  • Adult
  • Case-Control Studies
  • Catheter-Related Infections / economics
  • Catheter-Related Infections / epidemiology
  • Catheter-Related Infections / prevention & control*
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Central Venous / standards*
  • Checklist
  • Female
  • Health Care Costs
  • Humans
  • Incidence
  • Infection Control / economics
  • Infection Control / organization & administration*
  • Intensive Care Units / economics
  • Intensive Care Units / organization & administration*
  • Los Angeles / epidemiology
  • Male
  • Patient Care Bundles / economics
  • Patient Care Bundles / standards*
  • Prospective Studies
  • Quality Improvement*