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Implement the IHI Central Line Bundle

Central venous catheters (CVCs) are being increasingly used in the inpatient and outpatient settings to provide long-term venous access. CVCs disrupt the integrity of the skin, making infection with bacteria and/or fungi possible. Infection may spread to the bloodstream (bacteremia) and hemodynamic changes and organ dysfunction (severe sepsis) may ensue possibly leading to death. Approximately 90 percent of the catheter-related bloodstream infections (BSIs) occur with CVCs. [1]

Forty-eight percent of ICU patients have central venous catheters, accounting for 15 million central venous catheter-days per year in ICUs. Studies of catheter-related bloodstream infections that control for the underlying severity of illness suggest that attributable mortality for these infections is between 4 and 20 percent. Thus, it is estimated that between 500 and 4,000 US patients die annually due to bloodstream infections. [2]

In addition, nosocomial bloodstream infections prolong hospitalization by a mean of 7 days. Estimates of attributable cost per bloodstream infection are estimated to be between $3,700 to $29,000. [3]

Care bundles, in general, are groupings of best practices with respect to a disease process that individually improve care, but when applied together result in substantially greater improvement. The science supporting the bundle components is sufficiently established to be considered standard of care.

The IHI Central Line Bundle is a group of evidence-based interventions for patients with intravascular central catheters that, when implemented together, result in better outcomes than when implemented individually.

The key components of the IHI Central Line Bundle are:

References

Mermel LA. Prevention of intravascular catheter-related infections. Annals of Internal Medicine. Mar 7 2000;132(5):391-402.
Soufir L, Timsit JF, Mahe C, Carlet J, Regnier B, Chevret S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: A matched, risk-adjusted, cohort study. Infection Control and Hospital Epidemiology. 1999 Jun;20(6):396-401.
Ibid.

Establish a Rapid Response Team
The Rapid Response Team, known by some as the Medical Emergency Team, is a team of clinicians who bring critical care expertise to the bedside.
Implement an Intensivist Model in the Intensive Care Unit (ICU)
Establishing an intensivist led model of ICU care has improved ICU mortality and decreased length of stay.
Implement Daily Goals Assessment
Daily goals assessment allows teams to keep track of plans established either on patient care rounds and/or multidisciplinary rounds and to verify their completion.
Implement Effective Glucose Control
Effective glucose control in the ICU has been shown to decrease morbidity across a large range of conditions and also to decrease mortality.
Implement Multidisciplinary Rounds
Multidisciplinary rounds enable all members of the team caring for patients to come together and offer expertise in patient care.
Implement the IHI Ventilator Bundle
Reducing mortality due to ventilator-associated pneumonia requires an organized process that guarantees the early recognition of pneumonia along with the uniform and consistent application of the best evidence-based practices.

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Measures: Prevent Central Line Infection

Care teams should measure each of the evidence-based interventions recommended by the How-to Guide: Prevent Central Line Infection.

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Central Line Insertion Checklist
Implementing a central line checklist at the time of insertion will help to ensure a reliable process.
How-to Guide: Prevent Central Line-Associated Bloodstream Infection
This How-to Guide describes key evidence-based care components of the IHI Central Line Bundle which has been linked to prevention of central line-associated bloodstream infections, describes how to implement these interventions, and recommends measures to gauge improvement.
What Is a Bundle?
IHI Vice President and patient safety expert, Carol Haraden, PhD, clarifies what a "bundle" is and is not, and suggests tips for using bundles most effectively to get results in improvement initiatives. While the allure of this tool is undeniable, says Haraden, quality teams should resist the impulse to label any list of good changes a bundle.