Aiming for zero: decreasing central line associated bacteraemia in the intensive care unit
Mary E Seddon, Catherine J Hocking, Pat Mead, Catherine Simpson
Central line catheters are an important aid to managing very sick patients and are used commonly in intensive care units (ICUs), where approximately 50% of patients will have such a line in place. However, these lines may cause serious infectionsknown as Central Line Associated Bacteraemia (CLAB)with a 10-50% mortality rate. Overseas literature has shown that the rate of these infections can be reduced to zero through the implementation of a bundle of carethe bundle is a number of evidence-based steps that when combined and used on every patient can significantly decrease infections. Counties Manukau DHB decided to introduce the CLAB prevention bundle in December 2008, organising the bundle into two checklists (one of inserting the line, and the other for maintaining it). Prior to introducing the checklists, the ICU had 1-2 patients with CLAB per month (a rate of 6.6/1,000 line days). After introduction the absolute numbers affected fell from 14 in 2008 to 4 in 2009 and only 1 in the first 6 months of 2010. The rate fell to 0.9/1,000. We continue to aim for zero and have now spread the learnings from this work to other areas in the hospital that use central lines.
