Are CVAD bundles effective in preventing CLABSI?
A systematic review and meta-analysis (Ista et al, 2016) aimed to quantify the effectiveness of central-line bundles (insertion or maintenance or both) to prevent CLABSI in ICU patients. In the meta-analysis the incidence of infections decreased significantly from median 6·4 per 1000 catheter-days (IQR 3·810·9) to 2·5 per 1000 catheter-days (1·44·8) after implementation of bundles (IRR 0·44, 95% CI 0·390·50, p<0·0001; I2=89%). Implementation of central-line bundles has the potential to reduce the incidence of CLABSIs in ICU patients.
Zingg and Pittet (2016) caution that success frequently relies on adaption of the strategy to the local context; therefore, it is important to understand the complexity of an innovation and culture of a setting. Bundles prevent central-line infections, but their successful implementation needs multimodal approaches adapted to local realities.
Ista E, van der Hoven B, Kornelisse R, et al. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. Lancet Infect Dis. 2016 Feb 18. pii: S1473-3099(15)00409-0. doi: 10.1016/S1473-3099(15)00409-0. http://www.sciencedirect.com/science/article/pii/S1473309915004090
Zingg W, Pittet D. Central-line bundles need a multimodal implementation strategy. The Lancet Infectious Diseases, 2016;16(6):631-632. https://www.sciencedirect.com/science/article/pii/S1473309915004806