| Summary: | 碩士 === 義守大學 === 管理碩博士班 === 102 === The concept of bundle care has been introduced globally to reduce the incidence of blood stream infection associated with central venous catheterization (i.e., central line-associated bloodstream infection, [CLABSI]) which is an important indicator of the safety and quality of patient care.
The study aimed at investigating the effectiveness of implementing bundle care against CLABSI in an intensive care setting. Parameters for comparison included the site of catheter insertion, duration of catheter implantation, skin disinfectant used, extent of aseptic area for the procedure, bacterial species isolated, and the incidence of CLABSI.
Data were retrospectively collected from five intensive care units (ICU) for adult patients at a tertiary care hospital. Study parameters were compared between the period before (July 2011 – December 2011) and after (July 2012 – December 2012) bundle care implementation. Bundle care included: (1) Proper hand hygiene; (2) Appropriate site of catheterization; (3) Effective skin disinfection; (4) Adequate aseptic area for the procedure, and (5) Daily evaluation of the possibility of catheter removal. Inclusion criterion included patients receiving central venous catheterization for the first time in an ICU setting, while patients with diagnosis of advanced malignancy were excluded from this study. Data randomly acquired from medical records, the infection control unit, and the Department of Information Technology at the institute were analyzed with Chi-Square test and Student t-test for categorical and continuous variables, respectively, using the SPSS 19.0 software.
There was no significant impact regarding the site of catheterization (P=0.419 vs. P=0.087 before and after bundle implementation, respectively) and the duration of catheter implantation (P=0.883 vs. P=0.916) on the incidence of CLABSI. On the other hand, staphylococcus aureus significantly predominated among all identified pathogens during both study periods (P=0.002 vs. P=0.000). Other changes between the periods before and after the implementation of bundle care included changing skin disinfectant from 70% alcohol and iodine solution to 2% Chlorhexidine, the shift from local aseptic area to maximum aseptic area for the procedure, knowledge regarding the implementation of bundle care from 69±13 to 90±12 (P=0.025), and the increase in compliance with proper hand hygiene from 91% to 96%. The overall incidence of CLABSI decreased from 6.2‰ to 4.4‰ after implementation of bundle care.
The results of the present study demonstrated that the implementation of a bundle care strategy with standard operating procedure incorporating refined measures for infection control, good compliance of medical and nursing staff, and effective discussion for continual healthcare quality improvement significantly reduced the incidence of CLABSI in an ICU setting.
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