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The long-term effect of bundle care for catheter-related blood stream infection: 5-year follow-up
  1. Ho-Tsung Hsin1,2,
  2. Meng-Shiuan Hsu3,
  3. Jiann-Shing Shieh2
  1. 1Cardiovascular Intensive Care Unit, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
  2. 2Department of Mechanical Engineering, Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Tauyuan City, Taiwan
  3. 3Division of Infectious Disease, Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
  1. Correspondence to Dr Ho-Tsung Hsin, Cardiovascular Intensive Care Unit, Far-Eastern Memorial Hospital, New Taipei City, Taiwan 13F, No. 21, Sec. 2, Nan-Ya S. Rd, Banciao Distr., New Taipei City 220, Taiwan; hsinht{at}


Objective To address the importance of bundle care for catheter-related infection (CRBSI) on the basis of long-term observation in a catheter-abundant cardiovascular intensive care unit (CVICU).

Design Prospective longitudinal cohort study.

Setting CVICU of a tertiary referring medical centre in northern Taiwan.

Participants Around 1400 critically ill patients annually for 5 years in the CVICU (from January 2010 to June 2015). CRBSI bundle care has been applied ever since by a multidisciplinary team.

Main outcome measures CRBSI per 1000 catheter days, bloodstream infection (BSI) per 1000 inpatient days, and catheter utilisation rates.

Results From January 2010 to June 2015 (22 quarters), there were in total 45 140 inpatient days and 24 163 catheter days, with an overall central venous catheter utilisation rate of 53.5%. The duration of the indwelled catheter was 6.3±1.2 days. The beginning CRBSI rate was 7.0 per 1000 catheter days and was significantly decreased to 0.7 per 1000 catheter days (p<0.001). Regarding the time series, cubic polynomial function depicted the CRBSI decrement most vividly (R2=0.501, p=0.005). In addition, the improvement in overall BSIs (2010 Q1, 4.4 per 1000 inpatient days to 2015 Q2, 0.5 per 1000 inpatient days, p<0.001) significantly correlated with the decrease in CRBSI (r=0.86, p<0.001).

Conclusions Through the bundle care, we successfully reduced CRBSIs. After 5 years of follow-up, we observed that the effect of bundle care was stepwise and persistent, as long as we kept working on this integrated project.

Statistics from


  • Contributors H-TH organised the team, conducted the study and finished the manuscript drafting. M-SH designed the study protocol and reviewed the monthly outcome. J-HS was in charge of data analysis and statistical works.

  • Competing interests None declared.

  • Ethics approval FEMH IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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