A review of the effectiveness of evidence-based recommendations for prevention of catheter related bloodstream infections in intensive care unit patients

Objective: Although central venous catheter (CVC) is a vital initiative, it causes serious complication among intensive care unit (ICU) patients. The most important of these is catheter related bloodstream infection (CRBSI). CRBSI increases morbidity, mortality and costs. The aim of this review is to examine the results of implemented interventions as the bundle of evidence-based guidelines recommendations for prevention and/or reduction of CRBSI among adult hospitalized patients in the ICU. Material and Methods: In order to reach the relevant study, BMJ Online Journals, Cochrane, EBSCOhost, Elsevier Science Direct, Medline, OVID-Lippincott Williams & Wilkins database were scanned. The full text can be accessed, published between 2000-2014, English studies were included in the review. All studies that have implemented the preventive bundle approach in adult patients who had non-tunneled central line in the ICU and have reported the CRBSI rate or number of event were included in the review. A standard assessment has not been made with regard to design or methodological quality of reached studies. Results: Twenty one studies were included in the review. The initiatives implemented in the study were presented in the following categories: education, prefer to subclavian site, evaluation of CVC requirements, hand hygiene, maximal sterile barrier precautions, chlorhexidine for skin antisepsis, checklist, empowering nurses to stop procedures, CVC insertion cart, adequate catheter care, replacement of administration sets, needleless intravascular catheter systems, evaluation of adherence to guidelines and other initiatives. Statistically significant reduction was found between the preintervention and postintervention period for CRBSI rate in 18 studies except only one study. In only one study, CRBSI rates between preintervention and postintervention period were equal. Conclusions: CRBSI rate was shown to decrease between 26% at first year of intervention and 95% at second year after intervention with implemented as the bundle of recommended interventions in the guidelines. As a result, the bundle approach has been revealed to be effective and sustainable to reduce CRBSI in adult ICU patients.