Catheter associated bloodstream infection (CRBSI) occurring in the neonatal intensive care unit (NICU) are frequent, complication related to it are potentially fatal and costly (Kim & Sandra, 2009). According to the center of disease control, an approximate of two hundred and fifty thousand cases of CRBSIs have been estimated to occur annually which cause health care to cost approximately twenty five thousand dollars per case, and between 500 to 4,000 patient die due to blood stream infection (CDC, 2002). Approximately 90 percent of blood stream infection occurs from central venous insertion (CVC). Even though CRBSI occurs from different ways, the most common source is contamination of the catheter by skin flora on insertion, skin flora contaminating the external catheter, hub or both. In pediatric and neonatal ICUs, CRBSIs vary from 3.8 to 11.3 per thousand catheter days and account for around 30% of all nosocomial infections (Kim & Sandra, 2009). These statistics make preventing central venous catheter related bloodstream infections extremely important. Also, effective October 1, 2008, the Centers for Medicare and Medicaid Services have stopped reimbursing hospitals for conditions that have evidence-based prevention guidelines, which includes catheter-related bloodstream infections Center for Medicaid & Medicare service, ( n.d.).
CRBSIs could lead to result in additional therapy and prolonged hospital stay. However, these vascular access devices are essential aspects of neonatal care for administer intravenous fluid and medication. Nurses perform much of the daily care of central venous catheters. Therefore, nurses play an integral role in preventing bloodstream infections. As CDC recommend, changing form standard practice to evidence based practice guidelines can decrease catheter related infection and increase patient care outcome. Research support use of central line bundle as one of the best evidence based intervention to reduce CRBSI (Institute of health care improvement, 2010.).
Central line bundle is a group of evidence-based practice strategy for patient with central catheters, when implemented together, produce better outcomes than implemented individually (Institute of health care improvement, 2010.). The main elements of central line bundle are hand hygiene, maximal barrier precaution upon insertion, Chlorhexidine skin antisepsis, optimal catheter selection, and daily review of line necessity with prompt removal of unnecessary lines Aseptic technique when using and caring for a central line catheter can decrease the chance of contamination in this critically ill infants. Staff education on adherence to aseptic technique and strict central line care guidelines are essential to decreasing bloodstream infections.
The purpose of this author for this project is to analyze current literature reviews to establish a firm basis to implement evidence based central line bundle intervention to decrease catheter related blood stream...