Central line-associated bloodstream infections (CLABSI) and major vascular injuries (MVI) are serious but preventable complications in patients requiring central venous access devices (CVADs).

 

To determine the effectiveness of a comprehensive care bundle (CCB) in adult patients with CVAD in reducing the rate of CLABSI and MVI in a major tertiary hospital.

 

Pre-and-post intervention study using ICU-CLABSI data reported to the Australia and New Zealand Intensive Care Society (ANZICS) and MVI-data from CVAD audit in patients admitted to The Canberra Hospital between February 1, 2018, to January 31, 2022. The pre-intervention (February 1, 2018, to January 31, 2020) review of CVAD complications indicated significantly higher CLABSI and MVI than peer hospitals.

 

At the institutional level, we introduced an evidence-based CCB, checklist, policy, and education package through a literature review and multi-disciplinary collaboration addressing system and operator-focused changes on February 1, 2020.

 

The post-intervention cohort had a significantly lower CLABSI rate than the pre-intervention (0.32 vs.1.1 per 1000-line days, 3 incidences per 9283-line days vs. 10 incidences per 9079-line days, P<0.001) despite significantly higher risk factors in the form of CVAD line days (387vs378, P<0.001), number of patients on mechanical ventilation (1739 Vs. 1687, P=0.005), immunosuppressive diseases (318 vs.119, P<0.001), leukaemia (99 Vs. 81, P=0.038) and hepatic diseases (97 Vs. 71, P=0.006). No MVI was reported post-intervention compared to four in the pre-intervention cohort.

 

The CCB decreased the incidence of CLABSI and MVI in patients in a tertiary ICU.

 

Introducing a multi-disciplinary CCB for CVAD insertion and maintenance decreased CVAD-related preventable complications and healthcare costs.

 

Harshel G. Parikh1,2, Andrew Deacon3, Kiran Gudivada1, Mary Nourse1, Kelvin Grove1
 
 

1.     Intensive Care Unit, Canberra Health Services, Garran, ACT 2605

2.     Medical School, The Australian National University, Acton, ACT 2600

3.     Department of Anaesthesia, Canberra Health Services, Garran, ACT 2605