Catheter care bundle reduces bloodstream infections in long-term acute care hospitals

Long-term acute care hospitals that implemented a central catheter maintenance “bundle” reduced the rate of hospital-acquired central line-associated bloodstream infections (CLABSIs) in patients by 29%, according to a study in the March 2016 issue of American Journal of Critical Care.

A catheter care “bundle” is an evidence-based combination of interventions used to prevent CLABSIs, including hand hygiene, use of alcohol-based central catheter caps, application of a chlorhexidine-impregnated sponge dressing, replacement of transparent dressing at least every 7 days, daily assessment of the dressing site, and other measures.

The central catheter maintenance bundle in this study included 14 components as well as a 5-item checklist to monitor compliance. Researchers from Select Medical, an acute and post-acute care network based in Mechanicsburg, PA, included 30 of its long-term acute care hospitals to implement the maintenance bundle; these were hospitals that didn’t already have such an infection-reduction initiative in place.

Research shows that evidence-based prevention programs reduced CLABSI rates in intensive care units, but little research exists on the effect of these programs in long-term acute care hospitals. Most patients admitted to long-term acute care hospitals have chronic critical illnesses and already have a central catheter in place. By the time these patients transfer to a long-term acute care hospital, they typically have 10 to 15 comorbid conditions, have high rates of antibiotic use, and are at high risk for health care-associated infections, the researchers noted.

To discover how implementing a central catheter maintenance bundle could reduce the risk of bloodstream infections in the participating long-term acute care hospitals, the researchers reviewed the medical records of 6,660 patients discharged during the 14 months prior to the study and 6,559 patients discharged after implementation of the bundle.

Results showed that the rate of CLABSIs dropped by 29% after the hospitals implemented the catheter care bundle. In addition, each hospital averaged 4.5 fewer CLABSIs during the 14 months after implementing the bundle.

“This infection reduction could translate to a savings of approximately $3.7 million annually for the 30 long-term acute care hospitals studied and could have potentially saved 20 patients’ lives, assuming a 15% mortality rate from CLABSIs,” the authors concluded.