The CRBSI prevention project involved the development and piloting of guidance material on evidence-based interventions for preventing CRBSI and suggestions on how to implement practice change. Interventions in the guidance material developed by the project are based on the well established concept of ‘bundles’ of care components.
The care bundles are groupings of best practice interventions, which individually improve care but, when applied together, result in a significantly greater improvement. The CRBSI guidance material reflects internationally established best practice and consists of two bundles of evidence-based interventions which have been shown separately and together to prevent CRBSI.
The New Zealand CRBSI project care bundles are:
Central venous catheter (CVC) insertion bundle:
1. Hand hygiene
2. Maximal barrier precautions
3. Chlorhexidine skin antisepsis
4. Optimal catheter site selection.
Central venous catheter maintenance bundle
1. Daily review and documentation of line necessity and prompt removal of unnecessary lines
2. Dedicated lumen for total parenteral nutrition (TPN)
3. Access the CVC lumens aseptically
4. Daily review and documentation of entry site for inflammation and with every change of dressing.
The guidance material, which may be viewed by clicking on the following link, provides an explanation, evidence base and information on implementation of the above care bundles.
Initial draft guidance material was updated in light of consultation feedback from a wide range of interested organisations and clinicians. The updated draft was then piloted by the Auckland, Counties Manukau and Canterbury District Health Boards (DHBs) during September – November 2009.
The pilot activity confirmed the utility of the guidance material based on the real-world experiences of the units and clinicians who utilise central venous catheters. Feedback from the pilot sites also resulted in some refinement of the guidance material. Piloting was not undertaken to demonstrate the effectiveness of implementation of the guidance material in reducing CRBSI – that is because a pilot programme carried out within such a short timeframe cannot develop the statistical power to demonstrate the effectiveness of guidance material implementation.