In all the studies shown in the table below, there were positive effects of the interventions on the occurrence of central line-associated bloodstream infections. Three studies (Dixon & Carver, 2010; Guerin, Wagner, Rains, & Bessesen, 2010; Marra et al., 2010) indicated significant changes while the other two studies showed positive but insignificant results. Various factors led to the attainment of insignificant differences.
A difference in the type and manner of implementing the intervention bundle resulted in the variation of results. In addition, the methodology of all the different studies was different, even though two of the studies had the same type of research design. One study used a quasi-experimental research design, another study used a prospective-cohort, two studies used a pre-post study design, and the other one was part of a larger study.
In the latter study, it is likely that the sample selected was not solely meant for the evaluation of adults with central-line infections because there is hardly a mention of the sample used in this report (Hong et al., 2013). This study was quite comprehensive, and one would have expected significant outcomes. However, due to a lack of accurate targeting of the participants and valid strategies to minimize variation among the observers, researchers attained positive but insignificant results.
Despite the fact that significant outcomes were attained in the quasi-experimental approach, it is obvious that the samples were not the same (Marra et al., 2010). In addition, the nature of recruiting the intervention and control groups resembles that of a pre-post test research design of two studies because both groups were subjected to the same intervention; the only difference was that the samples were from different units.
An articulate inclusion and exclusion criteria helped to minimize the bias that usually affects the results. The studies that indicated positive results included an education component, the use of chlorhexidine, and a monitoring element. In studies that indicated a lack of significant results, there were no clear inclusion and exclusion criteria. In addition, one study was conducted in a non-ICU setting while all the others were conducted in ICU units.
Also, this study was conducted in an irregular manner because the nurses in the control wards were not the same as those in the intervention wards. Hence, there might have been a difference in performance, such that the nurses in the control wards were better performers than their counterparts in the intervention wards. Sequentially, better results were seen in the control group than the intervention group. The style of data collection in the study by O’Neil et al. (2016) was not carried out in a systematic manner, and there is no mention of how variation in observation between the researchers was resolved.
|Title of Study||Type of Study||Intervention||Results|
|Impact of a program to prevent central line-associated bloodstream infection (CLABSI) in the zero-tolerance era||Quasi-experimental in an intensive care unit and 2 step-down units||Multifaceted intervention approach that included the use of chlorohexidine, education of the staff, and monitoring||Incidence of CLABSIs significantly reduced from 6.4 to 3.2 at p< 0.001, while the mean incidence density also significantly decreased from 4.1 to 1.6 at p = 0.005|
|Decreasing central-line-associated bloodstream infections in Connecticut Intensive Care Units||Part of multifaceted national intervention in ICUs, CUSP: Stop BSI Program||Comprehensive intervention made up of three components: |
-A multifaceted intervention
-Comprehensive Unit-based Safety Program (CUSP)
-Measurement and performance feedback
|The mean of CLABSI reduced from 1.8 infections per 1, 000 catheter days to 1.1 by the end of the seventh quarter after the intervention. |
However, this decline was not significant (p= 0.066).
|Reduction in central line-associated bloodstream infections by the implementation of a postinsertion care bundle||Pre-post study in medical and surgical ICUs||A 2% chlorhexidine gluconate (CHG) in alcohol was used to make a solution used for dressing purposes. |
Training of the staff on the proper use of CHG-impregnated cloths
Frequent changing of IV tubings
|The incidence density of the CLABSIs significantly reduced from 5.7 to 1.1 per catheter-days (p=0.004) |
The relative risk after the intervention was 0.91%
|A central line care maintenance bundle for the prevention of catheter-associated bloodstream infection in Non-ICU settings||Pre-post study in a non-ICU setting||Multifaceted catheter care bundle including an education component, review, and update of hospital policies, use of visual aids, a revised and competent assessment procedure, monitoring and reporting on the outcomes, and provision of resources to ensure the maintenance of catheter care.||There was a reduction in the incidence density of CLABSI, though this was not significant. A small but significant decrease was observed in the control group. Thereby, despite the fact that the intervention helped in improving the catheter dressing care, significant decreases of CLABSI in non-ICU patients were not realized.|
|Daily chlorhexidine gluconate bathing with impregnated cloths results in a statistically significant reduction in central line-associated bloodstream infections.||Observation cohort in the surgical ICU||Quality improvement protocol entailing 2% chlorohexidine gluconate-impregnated cloths and an evidence-based bundle defined by the education of the staff on changes in CLABSI prevention strategies and policies as well as compliance with monitoring and documentation||There was a significant decline in the rates of CLABSI from 12.07 to 3.17 per 1000 central line-days, equivalent to a 73.7% reduction at P< 0.05|
Dixon, J. M., & Carver, R. L. (2010). Daily chlorohexidine gluconate bathing with impregnated cloths results in statistically significant reduction in central line- associated bloodstream infections. American Journal of Infection Control, 38(10), 817-821.
Guerin, K., Wagner, J., Rains, K., & Bessesen, M. (2010). Reduction in central line- associated bloodstream infections by implementation of a postinsertion care bundle. American Journal of Infection Control, 38(6), 430-433.
Hong, A. L., Sawyer, M. D., Shore, A., Winters, B. D., Masuga, M., Lee, H., …Lubomski, L. H. (2013). Decreasing central-line-associated bloodstream infections in Connecticut Intensive Care Units. Journal of Healthcare Quality, 35(5), 78-87.
Marra, A. R., Cal, R. G., Durão, M. S., Correa, L., Guastelli, L. R., Moura, D. F.,… & Dos Santos, O. F. (2010). Impact of a program to prevent central line- associated bloodstream infection in the zero tolerance era. American Journal of Infection Control, 38(6), 434-439.
O’Neil, C., Ball, K., Wood, H., Kathleen, M., Kremer, P., Jafarzadeh, S. R.,… & Warren, D. (2010). A central line care maintenance bundle for the prevention of catheter-associated bloodstream infection in Non-ICU settings. Infect Control Hosp Epidemiol., 37(6), 692-698.