Decreasing Central Line Associated Blood Stream Infections Jessica Mourlam

Introduction

Evidence-based practice should be the standard under which the units operate. This enhances quality care of patients. In an effort to decrease central line associated blood stream infections, we will look at what evidence-based practice is and the changes that will take place on the unit to decrease central line associated infections. We will also discuss why this is so important.

What is evidence-based practice?

Evidence-based practice is “recognized as the gold standard for quality healthcare” (Prasun, 2013, p.1).

Evidence-based practice relies on research. Research is used to provide evidence by which practices can change to ensure quality care of patients (Finkelman, 2016).

It is not: Implementing the findings based off of one study. Continuing to practice in a certain way because one learned it previously and that is the way in which it has always been done. This practice or intervention may be outdated (Prasun, 2013).

It is:

Best research evidence- reviews of relevant research (Prasun, 2013).

Clinical expertise- this is “practitioner knowledge or what is referred to as internal evidence” (Prasun, 2013, p.83). This may include diagnostic results and patient assessments.

These are coupled with patient values

Evidence Based Practice is important because looking for current evidence will improve patient outcomes. It challenges us to look for up to date information instead of just following traditions (Prasun, 2013).

Central line associated blood stream infection (CLABSI)
Central line associated blood stream infection (CLABSI)

"Health care–associated infections (HAIs) occur too often and at great expense to patients, health care providers, and payers. At any given time, about 1 in every 20 patients has an infection related to his or her hospital care" (Clancy, 2012, p. 191).

CLABSIs can have a 12-25% mortality rate (Clancy, 2012). THIS is why it is so important to reduce these infections!

Since central lines are in a large vein that is close to the heart, and they may remain in for weeks or months they can cause serious infections (CDC, 2011)

“Blood stream infections are a major cause of morbidity and increased mortality in healthcare and are also attributed to an increased length of stay and escalating costs” (Medina, Serratt, Pelter, Brancamp, 2014, p.133).

There are more than 250,000 cases of hospital acquired blood stream infections each year in the United States related to central lines (Medina, et al., 2014).

Why do CLABSIs occur?

Lack of written policies, formal training, and experience can contribute to CLABSIs (Bianco, Coscarelli, Nobile, Pileggi, Pavia, 2013)

Lack of hand hygiene or following sterile procedure that may introduce bacteria into the central line (CDC, 2010)

Central lines staying in longer than needed can cause an increase in chance of acquiring a blood infection (CDC, 2010).

Infections can result from the patients skin bacteria (Medina, et al., 2014).
Changes that will be made to reduce CLABSIs

We will adhere to the Center of Disease Control’s (CDC) checklist for central lines. We currently do not have a checklist in place that we follow.

Clinicians will also have new responsibilities. They will have daily audits in their Soarian to assess if their patient still needs the central line.

Insertion practices per CDC will be adhered to. These will show up in the central line insertion checklist that should be filled out by the nurse in Soarian. We will discuss this shortly.

Chlorhexidine gluconate is an antiseptic that is kills a number of different bacterias, yeast and molds. Giving baths with CHG wipes has been proven to reduce infections anywhere from 32-87% (Medina, et al., 2014)

CHG daily baths will now be mandatory for all patients that have a central line. There will be a mandatory class to instruct on how to properly give these baths along with a handout that reinforces the instructions (Medina, et al., 2014). . This bath will also been included in a daily assessment in Soarian to reinforce it being completed. It will be in the line maintenance checklist—will discuss later.

A central line insertion cart that carries all the proper equipment and materials to insert a central line will now be place on every unit. This ensures that all materials and sterile equipment are available to insert a central line in an emergency. Having these supplies ready reduces risk of infections from insertion of a central line. (Medina, et al., 2014).

Insertion checklist

An insertion checklist will be filled out in Soarian- this will ensure that the proper time of insertion is documented and steps that need to be done during insertion were completed. The primary nurse of the patient during the insertion will be responsible for completing this checklist. This is a checklist that will just be filled out once, during the insertion of the central line. This is the checklist in the CDC guidelines:

  • Proper hand hygiene before insertion
  • Aseptic technique
  • Sterile barrier precautions were used such as sterile gloves, sterile gown, mask,cap and drape
  • Choose the best site to avoid infections. Subclavian is optimal
  • Cover the site with a sterile dressing (CDC, 2010).
Line maintenance checklist

In addition to the insertion checklist there will now be a line maintenance checklist in Soarian- this will require the nurse caring for the patient to put in when the central line dressing was changed and assess the dressing. The assessment will trigger the nurse to change the dressing if it is due according to the last dressing change or if the assessment reveals the dressing is in jeopardy of not being sterile. Dressings that are soiled, wet or dislodged must be replaced (CDC, 2010). This assessment will also require the nurse to ask the doctor if the patient still needs the central line. The shorter amount of time a central line is in the less chance there is of acquiring an infection (Medina, et al., 2014).

The Quality Improvement team in the hospital will keep track of these assessments to make sure they are completed.

Impact

The hospital will continue to track CLABSI rates. I will specifically monitor those patients with central lines in my unit. We will track how many days the central line is in and if the assessments in Soarian are being followed.

We will follow up with results of CLASBI rates in 3, then 6, then 12 months time to see if our changes have decreased infection rates.

Conclusion

The goal of these new initiatives is to improve patient outcomes. That should be our number one goal working in a hospital; to give the best care possible. By reducing CLABSI rates patients will improve with regards to their outcomes from their hospital stay. The quality of care we give to our patients will improve. In addition, we will dramatically reduce the costs that are associated with these infections

References

Bianco, A., Coscarelli, P., Nobile, C. G., Pileggi, C., & Pavia, M. (2013). The reduction of risk in central line-associated bloodstream infections: Knowledge, attitudes, and evidence-based practices in health care workers. American Journal of Infection Control, 41(2), 107-112. doi:10.1016/j.ajic.2012.02.038

Centers for Disease Control (CDC). Central Line-associated Bloodstream Infections: Resources for Patients and Healthcare Providers. (2010). Retrieved December 02, 2016, from http://www.cdc.gov/hai/bsi/clabsi-resources.html

Clancy, C. M. (2012, September). Eliminating Central Line-Associated Blood Stream Infections: Progress Continues on a National Patient Safety Imperative. Journal of Nursing Care Quality, 27(3), 191-193. doi:10.1097/NCQ.0b013e31825733d1

Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd edition). Upper Saddle River, NJ: Pearson.

Medina, A., Serratt, T., Pelter, M., & Brancamp, T. (2014). Decreasing Central Line–Associated Bloodstream Infections in the Non-ICU Population. Journal of Nursing Care Quality, 29(2), 133-140. doi:10.1097/ncq.0000000000000034

Prasun, M. A. (2013). Evidence-based practice. Heart & Lung: The Journal of Acute and Critical Care, 42(2), 84. doi:10.1016/j.hrtlng.2012.12.006

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