The Issue
Central line–associated bloodstream infections, also know as central line–associated bacteraemia (CLAB), are one of the most common and lethal complications of hospital care. They can occur when a central venous catheter is not inserted or maintained properly. Research shows, however, that such infections can be reduced or avoided altogether through appropriate preventive procedures.
What the Study Found
This study, by former Commonwealth Fund Harkness Fellow Mary Seddon and colleagues, describes the effort to eliminate CLAB among critical-care patients in one New Zealand institution, Middlemore Hospital. The intervention, begun in December 2008, included the following components:
- engagement with leaders of the intensive care unit (ICU) and education of ICU staff;
- the introduction of a CLAB prevention "bundle" of evidence-based care protocols, reinforced through checklists for central-line insertion and line maintenance;
- the development of a central-line pack, including hat, gloves, mask, gown, and other elements to complete the line insertion; and
- rapid feedback of the results.
The number of CLAB at Middlemore fell from 14 in 2008 to four in 2009, and then to just one in the first half of 2010. Conservatively estimated cost savings were approximately NZ$200,000 (US$152,200) in 2009 and NZ$260,000 (US$197,900) in 2010.
Conclusions
The authors conclude that it is possible to significantly decrease CLAB among critical-care patients using evidence-based care protocols. The effort reduced patient morbidity and mortality, while also reducing spending.
