birth, intensive care unit (ICU) admissions), insertion and removal date, insertion vein, and CVC indication (total parenteral nutrition, hemodynamic monitoring, dialysis, antibiotics and ‘other’ uses, independent of the number of days or times of that specific use of the CVC) are reported. Each CVC contributes to the number of CVC days. Hospitals participating in the CRBSI surveillance could choose to participate in the DHPSP CRBSI‐prevention programme and report bundle compliance. Box 1: Six‐item bundle to prevent CRBSI: Definitions of the bundle items Bundle compliance Bundle compliance was evaluated as a total (“overall”) bundle and in two partial bundles: an insertion bundle, comprising the four interventions to optimize aseptic/sterile insertion of the CVC, and a maintenance bundle, comprising the two daily checks. These maintenance items needed to be performed and recorded daily in order to be recorded as being complied with. Reporting of compliance with the bundle elements could be manual or in an electronic hospital system. For the analyses we distinguished compliance (all six bundle items were complied with) versus noncompliance (all six items recorded Insertion bundle elements: 1. Hand hygiene: All hospital personal who took part actively in inserting the CVC must disinfect their hands. 2. Precautions during insertion: the patient is covered with a sterile drape to at least 80%, including the head and hair when inserting in the jugular or subclavian vein, and the clinician and assistants wear sterile gowns and gloves, a hat, and a mouth nose mask. 3. Disinfection of the skin: The skin should be disinfected with 0.5% chlorhexidine in 70% alcohol before insertion. 4. Selection of insertion site: Choose the most optimal insertion site in descending preference: 1) v. subclavian, 2) v. jugular, 3) v. femoral. Deviation of this preferred order is accepted when documented. Maintenance bundle elements: 5. Daily check on indication: Every day it should be checked that the indication for the CVC is still valid; otherwise, the CVC should be removed within 24 hours. 6. Daily check on insertion site: Every day the insertion site should be checked for infection symptoms; when there are infection symptoms, the CVC should be removed within 24 hours. 218 Chapter 9
RkJQdWJsaXNoZXIy MTk4NDMw