Marjon Borgert

138 Chapter 6 Exline 36 2013, USA, Central line bundle Obser- vational cohort study with historical controls. Historic controls not used for compli- ance Baseline: Jan‘08-Dec‘09. Intervention year 1: Jan- Dec‘10, Intervention year 2: Jan- Dec‘11 Medical ICU, (25 beds) Quarterly CLABSI rates. Compliance with CVC insertion and dressing main- tenance practices. ICU nur- ses and physici- ans NS AON/ Audit per month 1) Insertion checklist, 2) Audit and feedback by infection preventionists: compliance per month and CLABSI per week, 3) Educational meetings, 4) Mandatory demonstration ses- sion for dressing change and proper line access on manikin, 5) Nurses were empowered to stop the procedure if sterile technique was not correctly employed. 6) Insertion trays were augmented with components to comply with central line bundle, 7) Coat pins 8) implementation teams, 9) unit physician and nursing leadership,10) case reviews Compliance with inserti- on practices: 100%. Compliance with dressing maintenance: 80-100% during the intervention period. McPeake 37 2012, UK, Central line bundle Quality improve- ment: Pros cohort Jun ’08-Dec ’10 General ICU (Number of beds NS) CLABSI rate Compliance ICU nurses PDSA cycles AON/ Per month 1) checklist, 2) performance feedback, 3) education, 4) run charts on trolley, 5) Evaluation when compliance with an element was poor 6) checklists for insertion Jun ’08: 67% Dec ’10: 100% Mc Namara 38 2011, USA, Central line bundle Retrospec- tive study Oct’08- Apr’10 General ICU (89 beds) Bundle documen- tation Nurses NS Lowest level of compliance + item- by-item/ Per month 1) feedback to included units and nursing sta , 2) audit, 3) electronic insertion checklist, 4) time-out procedure Compliance: Oct ‘08: 20% - Apr. ’10: 80%. Helmick 39 2014, USA, Central line bundle Retrospec- tive review 2009-2011 Multicentre: 5 mixed, 4 medi- cal, 4 surgical and 2 cardiac ICUs. Mean rates of CRBI NR NS Lowest level of com- pliance/ Per month 1) Checklists 2009: 95.86% 2010: 98.31% 2011: 97.51% P 0.38 Lawrence 16 2012, Australia, Ventilator bundle Pre/post design Total period: Apr’09-Mar 10. Pre-interven- tion 6 months, Intervention: 6 months 2 General ICUs, 8 beds Compliance Nurses NS AON/ Overall: 6 months 1) feedback of compliance rates using a graphical presen- tation. Pre interven- tion (n=164): 65.2% Inter- vention (n= 151): 67.5% (p-value Chi-square: 0.754) Morris 40 2011, UK, Ventilator bundle Pre/post design Baseline: Jan ’05 - Feb ’08. Run in period: Feb ’08-Sept ’08. Post VAP prevention period: Sept ’08 - Aug ’09. Medical & surgical ICU, 18 beds VAP incidence MRSA rates Duration of MV ICU LOS ICU mortality Nurses and medi- cal sta PDSA-cycle AON/ Overall: 1 year 1) distribution of teaching materials; 2) Education sessions; 3) Feedback on compliance at meetings, by email, with posters; 4) bedside cues; 5) changing the 24h observational chart (checklist); 6) nurse and medical champions. Post imple- mentation period: 70%