Intervention Effectiveness: A Meta-analysis of the Central Line Bundles to Prevent Catheter-Related Bloodstream Infections

Abstract

Objective: The aim of this study is to review the effectiveness and contributions of preventive care bundles in the treatment of CRBSI in the ICU, and to systematize the evidence-based interventions via a meta-analysis. Materials and Methods: Data sources; literature search was performed with “care bundle, nursing, care, central catheter, infection, catheter, central venous catheter-related bloodstream infection”. Study selection: after establishing the criteria for inclusion into the meta-analysis, studies were selected. A meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocol. Subsequently, all analyses made for meta-analysis calculations were recorded during the data coding phase: direct coding was implemented that analyzed sample numbers, arithmetic means, standard deviations, and research results. The positive effect size value indicates that the care bundle is more effective than traditional applications to prevent CRBSI. Data synthesis: MetaWin Statistical and The Comprehensive Meta-Analysis Software were employed to calculate effect size, variance, and group comparisons. In this meta-analysis an evaluation of effect size was realized according to the Cohen classification system (low between 0.20 and 0.50, medium between 0.50 and 0.80, higher than 0.80). The standardized effect size was used because of unusual characteristics and differences between measurement tools. Results: According to this meta-analysis, central line bundles reduced CRBSI by 68 % in the ICU and 52 % in clinics. The studies in the meta-analysis show an average effect size at ahigh level, in homogenous distribution, and coherent with fixed effects. Central line bundles described in the literature with low achievement rates due to mixer variables were not included in the meta-analysis. Conclusion: A Reformulation in the approach to CRBSI is required. The use and effectiveness of care bundles indicate the benefit of developing a guideline that decreases the rate of CRBSI, reduces complications, and increases the quality of health care.