Impact of Training on Central Line Associated Blood Stream Infection Maintenance Bundle on Central Line Associated Blood Stream Infection Rates - A Retro-prospective Study in a Selected Hospital, Hyderabad
Authors: Ardhalapudi Sumathi , Mani Dr. Ratna , K Pravalitha. 
Published: July 2022

Background: Central line-associated bloodstream infections (CLABSI) are a very common cause of healthcare-associated infections (HAI). CLABSIs will not only increase mortality and morbidity but also increases length of stay (LOS) and financial burden to ICU patients. Infection control practices play a major role in preventing CLABSI. Research indicates that quality improvement initiatives have helped in reducing CLABSI rates. CLABSI rates have been successfully reduced in ICU settings however, there is still significant variability in practice due to poor adherence to evidence-based CLABSI maintenance bundle components. However, nurses frequently struggle to follow evidence-based preventive practices, thus it is necessary to understand better the behavioral influences on implementing CLABSI prevention measures. Additionally, it has been emphasized that implementation studies must consider or quantify the potential impact on CLABSI rates. Before taking up the study, we have noticed increase in CLABSI rates for 1month Period, for which the Retrospective data was collected and analyzed to understand the gaps to implement CLABSI maintenance bundle components. Therefore, this study helped us identifying gaps in maintenance bundle and observed infections rates before and after study
Aim: To evaluate the effect of central line (CL) bundle compliance on central line-associated bloodstream infections (CLABSIs)
To evaluate the knowledge and practices of physicians and nurses working in all ICUs and wards regarding the components of central line maintenance bundles (ref table I)
Design: Used a retro prospective study, to reduce the CLABSI rates and to increase awareness on maintenance bundle components in intensive care units (ICU) and wards. we have initiated a structured training program to all nurses and doctors. Two tools were prepared. one is to assess the knowledge of nurses and doctors working in ICUs and wards on CLABSI. The second tool consists of components related to central line maintenance bundle to evaluate the effectiveness in reducing incidence of CLABSI. A total 489 Registered nurses and 10 intensivists and 15 ward doctors were included in the current study. Phase I was the pre-interventional period during this period audits were conducted, we observed lacunae in implementing CLABSI Maintenance bundle. Phase II was the intervention period lasting for 2 month, during this period, the entire nursing staff and doctors working in ICUs and Wards
underwent a continuous teaching and training. Phase III was the post-intervention period- In this period questionnaire was given in September and again in December. This was to check for the impact of training on knowledge and awareness level which will further lead better implementation of the practices. Observed CLABSI rate reduced from17.2. to 6.8 per 1000 central line days.
Result: Knowledge assessment- Comparison data between June 2021 and September 2021 mean knowledge score significantly higher in September (9.1) than June (6.4) .similarly, December (9.9) score significantly higher than June and September to determine the difference between the mean of various observations in the pre and post intervention period with 95% confidence interval, the difference in the knowledge level and CLABSI rate in the pre and post intervention period was found significant(p<0.001) .During this 6 months period(July 2021 to December 2021) there were a total of 1120 patients on central lines, for all the patients line care was observed after implementation of structured training programme. The rate of CLABSI significantly declined from 17.2 per 1000 catheter days to 6.8 per 1000 catheter days.
Conclusion: This study clearly indicated that the educational interventions in structured formats are imperative when imparting trainings in Infection control practices and should be implemented frequently to bridge the gap between knowledge and practice. With the dynamics of infection control and the challenges faced in its implementation continuing this type of trainings will ensure all use evidence-based interventions.
Recommendations: Continues Training program should be carried out for nurses and doctors related to implementation of CLABSI Bundle.

Keywords: CLABSI, Catheter hub care, Hand hygiene, Training, Maintenance bundle, Teaching, Implementing, Structured program.