Just over a decade ago, central line infections were seen as an inevitable, iatrogenic, consequence of care rather than a negative outcome that could be avoided with a group of simple preventative interventions. If a patient suffered a line infection, an investigation to identify probable cause would be rare. However, in recent years, healthcare culture has been transformed from a role of acceptance to one that acknowledges and learns from human error (Leape 1994).
The published literature concerned with approaches to patient safety involves an array of strategies. One term in common use to describe multiple interventions brought together to improve patient outcomes and reduce human error is ‘bundle’ (Hughes 2008). Resar et al (2012:2) define bundles as a “small set of evidence-based interventions for a defined patient segment/population and care setting that, when implemented together, will result in significantly better outcomes than when implemented individually”. The result of central line bundle implementation has significantly reduced infections over the last decade. From a global perspective, central line bundle implementation reduced infections between 39% in developing countries (Leblebicioglu et al 2013) and 66% in developed countries (Pronovost et al 2006).
Global evidence of this type influences governments and policy makers who recommend bundles to prevent central line infections (Cole 2012; O’Grady et al 2011). Published guidelines that provide evidence-based recommendations for preventing intravascular catheter-related infections, published by the Centers for Disease Control and Prevention (CDC) strongly recommend “hospital-specific or collaborative-based performance improvement initiatives in which multifaceted strategies are ‘bundled’ together to improve compliance with evidence-based recommended practices” (O’Grady et al 2011:57).
Click here to view IV policies/guidelines that describe the benefits of bundles.
COLE, S. (2013) Scottish Intensive Care Society Audit Group: Central line insertion bundle (2nd edition). NHS National Service Scotland. [online]. Last accessed 10 August 2013 at: http://www.sicsag.scot.nhs.uk/HAI/SICSAG-central-line-insertion-bundle-120418.pdf
HUGHES, R.G. (2008). Nurses at the “Sharp End” of Patient Care. In: HUGHES, R.G. (editor) (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, Agency for Healthcare Research and Quality. [online]. Last accessed 22 August 2013 at: http://www.ncbi.nlm.nih.gov/books/NBK2672/
LEAPE, L.L. (1994). Error in medicine. JAMA, 272(23), 1851-7.
LEBLEBICIOGLU, H., ÖZTÜRK, R., ROSENTHAL, V.D.et al. (2013). Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC). Annals of Clinical Microbiology and Antimicrobials. [online]. Last accessed 8 August 2013 at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674978/pdf/1476-0711-12-10.pdf
O’GRADY, N.P., ALEXANDER, M., BURNS, L.A., et al. (2011). HICPAC. Guidelines for the Prevention of Intravascular Catheter-Related Infections. (CDC Guidelines). Centers for Disease Control. [online]. Last accessed 18 August 2013 at: http://www.cdc.gov/hicpac/BSI/BSI-guidelines-2011.html
PRONOVOST, P., NEEDHAM, D., BERENHOLTZ, S.et al. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine. 355(26), 2725–2732.
RESAR, R, GRIFFIN, F.A., HARADEN, C., et al. (2012). Using Care Bundles to Improve Health Care Quality. IHI Innovation Series white paper. Cambridge. Massachusetts: Institute for Healthcare Improvement. [online]. Last accessed 2 August 2013 at: http://www.ihi.org/knowledge/Pages/IHIWhitePapers/UsingCareBundles.aspx