Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review.
Daniele Cristina Perin, Alacoque Lorenzini Erdmann, Giovana Dorneles Callegaro Higashi and 1 others
PMID 27598378WHAT IT FOUND
Central line infection rates in adult ICUs fell when units used bundles with hand hygiene, chlorhexidine skin prep, avoiding femoral sites, daily line checks, training, surveillance and feedback.
Some devices did not help.
Key findings
01Twenty-six of the 34 included studies reported significant reductions in CLABSI rates after care measures.
02Nine studies focused on care bundles combined with education, safety culture or organizational strategies, and one bundle audit study reported average infection rates falling from 6.43 to 1.83.
03Non-return valves did not prevent backflow or bacterial filtering, and silver-nanoparticle catheters showed no significant effect.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review only included studies published from January 2011 to July 2014, so newer practice changes may not be covered. It only covered adult ICU patients with short-term central venous catheters, not pediatric or neonatal patients, PICCs, hemodialysis catheters, peripheral or arterial catheters. Many included studies were observational or pre/post designs, and only 6 of the 34 studies were randomized clinical trials. Bundle effectiveness depended on high compliance; one study found only 38% reported high compliance. Authors note limited Brazilian nursing literature and focus on only one type of catheter.
The easy way to misread this
Do not read this as proving that any single device prevents central line infections. The reductions came from combined bundles, compliance, education, surveillance and feedback, and some devices did not show significant benefit.