Karen Mardegan 1,2, Kerrie Curtis 1, Sam Radford 1,3, Donna Cameron 1, Lindsay Grayson 1,3
1 Austin Health, Heidleberg, VIC, Australia
2 La Trobe University, Bundoora, VIC, Australia
3 Melbourne University, Melbourne, VIC, Australia
Introduction
A plethora of studies in recent years have been published detailing the implementation of Central Venous Catheter (CVC) Insertion Bundles of care. Study aims and results showed a decrease in central line infection rates. Two aspects make this project different; the introduction of a CVAD Maintenance Bundle and the inclusion of all Central Venous Access Devices (CVADs) across the organisation.
Methods
Evaluation of practice, products, maintenance documentation and CVAD policies compared to best practice evidence was lead by a multidisciplinary Steering Committee. Subsequently a CVAD Maintenance Bundle was formalised incorporating new products (dressings and access valves), reinforcement of current practices (hand hygiene, daily review for necessity, aseptic non touch technique and flushing practices) and supported by revised hospital policies. Organisation wide communication and education preceded introduction of all bundle elements in May 2015.
Results
Review of maintenance bundle practices in April 2016 revealed improvement across all areas; 93% dressings intact (24% improvement), 89% dressings in good condition (72% previously), 96% clean access valves (33% improvement), 83% improved documentation (47% previously). Staph aureus bacteraemia rates have decreased from 1-2 per month in 2014 to 1 per month in the haematology/transplantation unit and 0 in the remainder of the organisation.
Conclusion
The introduction of the CVAD Maintenance Bundle appears to have had a beneficial impact on consolidating evidence based practices. Indications suggest an improvement in CVAD infection rates except in one high-risk patient cohort. This leads the project towards possible introduction of a high-risk maintenance bundle for this patient cohort.