Impact of two bundles on central catheter-related bloodstream infection in critically ill patients.
Cristobal Felipe Padilla Fortunatti
PMID 29211195WHAT IT FOUND
Simultaneous insertion and maintenance CVC bundles were followed by a lower catheter-related bloodstream infection rate, from 3.48 to 1.52 per 1000 catheter days.
Nurses cannot separate which measure caused the drop.
Key findings
01Only 51.5% of CVCs inserted in the unit had insertion-bundle records; overall insertion compliance was 93.8%, while maintenance compliance was 62.9%.
02Compared with the same months in 2015, the intervention period had 4 rather than 10 CRBSI cases, a rate of 1.52 rather than 3.48 per 1000 CVC days, and mean CVC duration of 5.9 rather than 8.3 days.
03The authors say the reduction cannot be assigned to one bundle measure because insertion records were low and maintenance compliance was moderate, and the design cannot prove causality.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was before-and-after without randomisation, so other changes over time could explain the lower infection rate. It was done in one adult medical-surgical ICU in Chile, so it may not transfer to units with different staffing, patients, or line practices. Patients in the two periods were not matched for CRBSI risk factors, because those data were not collected. Insertion-bundle documentation was missing for many CVCs, and maintenance-bundle compliance was only 62.9%, so the intervention was not delivered as intended. Maintenance compliance was judged from clinical records without checking accuracy. The study lasted only six months, so it does not show whether the effect would persist. Staff changes, including substitute nursing staff, occurred in the early months and could affect infection rates.
The easy way to misread this
Do not conclude that any single bundle measure caused the reduction. The insertion and maintenance measures were given together, records were incomplete, and the before-after design cannot separate the intervention from other changes.