According to this study:

* A series of interventions implemented at once decreased catheter-related bloodstream infection rates.

* Successful implementation of these interventions was credited, in part, to the nurses' dedication.

Catheter-related bloodstream infections can be fatal, but reducing the risk of infection is possible. This was attempted in January 2006 when a community medical center implemented a "central line bundle," a series of interventions related to central line placement to be used by nurses in the study, and collected data on catheter-related infections for 15 months.

The bundle included seven different practice interventions. The first involved ultrasound guidance for proper site selection for peripherally inserted central catheters (PICCs). Second, barrier kits were distributed, and nurses were taught how to use them. Central line-insertion checklists were developed, and nurses became responsible for ensuring that proper barrier precautions were taken. (Editor's note: According to the Institute for Healthcare Improvement, maximal barrier precautions include handwashing and wearing a cap, mask, sterile gown, and gloves; see http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare/Changes/IndividualChang). Third, how to properly prepare the skin for a central line was taught (for example, cleansing skin and applying antiseptic), and revised dressing kits were stocked on the unit. Fourth, the hospital switched from a positive pressure intravenous connector system to a system specifically designed to protect the fluid pathway, which decreases infection risk. Fifth, nurses were trained to follow guidelines, written in accordance with Centers for Disease Control and Prevention standards, for disinfecting the septum connection and flushing the connector. Sixth, the flushing protocol was revised and a color-coded chart was developed for nurses to use in determining when to flush catheters and how much saline to use. Seventh, a tool for collecting data was developed to track a variety of catheter-related problems.

During the first 15 months after implementation of the central line bundle, 2,083 PICCs were inserted, and no infections were reported. By way of comparison, during the previous year 767 catheters were inserted and 11 infections occurred. The authors concluded that implementation of the seven interventions at one time was successful and that the success was due to the dedicated nurses, administrative support, and application of research and education principles.

SDSJ

Harnage SA. JAVA 2007;12(4):218-24.