The long-term effect of bundle care for catheter-related blood stream infection: 5-year follow-up.

ABSTRACT

OBJECTIVE: To address the importance of bundle care for catheter-related infection (CRBSI) on the basis of long-term observation in a catheter-abundant cardiovascular intensive care unit (CVICU). DESIGN: Prospective longitudinal cohort study. SETTING: CVICU of a tertiary referring medical centre in northern Taiwan. PARTICIPANTS: Around 1400 critically ill patients annually for 5 years in the CVICU (from January 2010 to June 2015). CRBSI bundle care has been applied ever since by a multidisciplinary team. MAIN OUTCOME MEASURES: CRBSI per 1000 catheter days, bloodstream infection (BSI) per 1000 inpatient days, and catheter utilisation rates. RESULTS: From January 2010 to June 2015 (22 quarters), there were in total 45 140 inpatient days and 24 163 catheter days, with an overall central venous catheter utilisation rate of 53.5%. The duration of the indwelled catheter was 6.3±1.2 days. The beginning CRBSI rate was 7.0 per 1000 catheter days and was significantly decreased to 0.7 per 1000 catheter days (p<0.001). Regarding the time series, cubic polynomial function depicted the CRBSI decrement most vividly (R2=0.501, p=0.005). In addition, the improvement in overall BSIs (2010 Q1, 4.4 per 1000 inpatient days to 2015 Q2, 0.5 per 1000 inpatient days, p<0.001) significantly correlated with the decrease in CRBSI (r=0.86, p<0.001). CONCLUSIONS: Through the bundle care, we successfully reduced CRBSIs. After 5 years of follow-up, we observed that the effect of bundle care was stepwise and persistent, as long as we kept working on this integrated project.