Page 54 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
th
11 National QA Convention, 4 – 6 October 2022
PP-16

Impact of Central Line Maintenance Bundle on Catheter-Related Blood-Stream Infection
in Critical Care Areas

Nur Izyanti MS, Nur Haslinda A, Raja Nor Azlina RAM, Nurul FNA
Institut Jantung Negara, Kuala Lumpur

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Healthcare-Associated Infections prevalence has increased by 1.2% due to an influx of Catheter-Related
Bloodstream Infections (CRBSI) in Critical Care Areas (CCA). A quality improvement initiative using the
Plan-Do-Study-Act model was commenced from April to December 2021 in all CCA.

KEY MEASURES FOR IMPROVEMENT:
The main goals were to reduce the risk for CRBSI in CCA from 4.4 per 1000 line-days to 3.9 per 1000 line-
days.

PROCESS OF GATHERING INFORMATION:
Daily laboratory and clinical surveillance were carried out during pre-implementation (July 2020 to March
2021) and post-implementation (April to December 2021) to assess outcomes from patients with relevant
clinical indicators. A compliance audit of the care bundle was conducted to assess staff performance.

ANALYSIS AND INTERPRETATION:
Fifty-one cases were identified from 11,903 patients with lines-days from July 2020 to March 2021. Non-
adherence to line care management was an influencing factor in patients acquiring CRBSI. Gaps in practice were
observed with 84% bundle compliance. 650 staff did not carry out at least one of the six bundle elements; hand
hygiene and daily review of line necessity and line care. Other contributing factors were increased admission
of critically ill patients with multiple comorbidities, prolonged length of stay and multiple readmissions from
ward to CCA.

STRATEGIES FOR CHANGE:
Action plans included revising components of the Central Line Maintenance Bundle, conducting education
programs, regular bedside teaching, developing education videos, optimising antimicrobial selections for
CRBSI patients, regular audits, daily assessment of line care maintenance and good hand hygiene practices.
Implementing a structured care bundle and standardisation of audit methodology has improved staff
understanding.

EFFECT OF CHANGE:
CRBSI rate was reduced to 3.6 per 1000 line-days from April to December 2021 (43 cases from 11,965 patients
with line-days). Staff adherence to the revised care bundle increased from 84% to 86%.

THE NEXT STEP:
Continuous monitoring and auditing of staff compliance to ensure the improvement is sustained. We are
planning to expand the improvement strategies to all wards.

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