Impact of the Central Line Check-list in an Intensive Care Unit of an Emergency Hospital

Background: Infections related central line catheters are an important source of morbidity and mortality among patients admitted in the Intensive Care Unit.

Objective: to evaluate the incidence of infections related catheters before and after the implementation central line check-list.

Methods: This is an observational prospective study developed in the Risoleta Tolentino Neves Hospital that is an teaching emergency community setting affiliated to the Federal University of Minas Gerais in Belo Horizonte, Brazil. There are 320 beds for clinical and surgical patients and 30 beds in the Intensive Care Unit. All the patients arrived from the Emergency Departure. The healthcare related infections were collected by an infection control practitioner using the National Healthcare Safety Network definitions. A team including a medical doctor and a nurse (both coordinators of the unit), a professor of the Nursing School affiliated to the hospital and the Infection Control Committee discussed the protocol of central line related infections. So they established the following measures: maximal barrier precautions upon insertion, chlorhexidine skin antisepsis, avoid femoral vein for central venous access, daily review of line necessity. The daily bedside round was performed by the coordinator of the nursing team, the nursing assistant and the nursing school professor. After the round the nursing assistant discussed with the medical doctor about the patients which catheters were judged by the round team could be removed. This study compared data from January to June/2010 in relation the data collected from July to October/2010 the check-list round implementation.

Results: It was included 83 rounds from July to October/2010. Two hundred sixty one patients with central line catheters were evaluated. Fifty nine infections related catheters were detected before the intervention and eleven after. Approximately 10.0% of the catheters could be removed after the round. The monthly incidency reduced from 26,7% to 1,4%. The number of patients with catheters and the severity of illness increased (APACHE II) but the length of stay reduced. All the differences where statistically significant

Conclusions: The preliminary data showed that the intervention was effective to reduce the infections related catheters.