Central Venous Catheter Maintenance Monitoring: It's Not Just for the IV Team!

Abstract

Background Central line-associated bloodstream infections (CLABSI) are a major cause of morbidity and mortality in acute care hospitals. Establishing a team that is dedicated to insertion & maintenance of central lines has been shown to decrease CLABSI. Methods To combat a rising CLABSI rate a dedicated team comprised to Infection Preventionists (IP) and Quality nurses was established to conduct daily observations of the central venous catheters (CVC) in the facility. The team primarily focused on tracking compliance to the maintenance bundle, which was comprised of 6 elements. Findings were communicated in real time to bedside nurses when issues were identified and to nurse managers for follow-up daily. Results The study results are focused on findings in the medical/surgical and neurological Intensive Care Units (ICUs). Compliance to parts of the maintenance bundle and the CLABSI rate improved after the dedicated team was put in place. One aspect of the bundle, correct placement of the chlorhexidine-gluconate (CHG)-impregnated sponge, improved from 73% at the beginning of the team audits in August 2018 to 88% after 6 months (February 2019), which was statistically significant (χ2= 6.371; 95% CI, 3.42%-28.88%; P = 0.012). The CLABSI rate in the ICUs in the 6 months prior to the intervention was 1.90 cases/1000 CVC days. In the 6 months following the initiation of the dedicated team the rate dropped to 0.00 cases/1000 CVC days. This difference was not statistically significant. Conclusions Fewer CLABSIs occurred in the ICUs and compliance to the CVC maintenance bundle increased following the initiation of daily audits by a dedicated team. Findings of the daily audits were communicated to nursing & nursing management daily. Central line-associated bloodstream infections (CLABSI) are a major cause of morbidity and mortality in acute care hospitals. Establishing a team that is dedicated to insertion & maintenance of central lines has been shown to decrease CLABSI. To combat a rising CLABSI rate a dedicated team comprised to Infection Preventionists (IP) and Quality nurses was established to conduct daily observations of the central venous catheters (CVC) in the facility. The team primarily focused on tracking compliance to the maintenance bundle, which was comprised of 6 elements. Findings were communicated in real time to bedside nurses when issues were identified and to nurse managers for follow-up daily. The study results are focused on findings in the medical/surgical and neurological Intensive Care Units (ICUs). Compliance to parts of the maintenance bundle and the CLABSI rate improved after the dedicated team was put in place. One aspect of the bundle, correct placement of the chlorhexidine-gluconate (CHG)-impregnated sponge, improved from 73% at the beginning of the team audits in August 2018 to 88% after 6 months (February 2019), which was statistically significant (χ2= 6.371; 95% CI, 3.42%-28.88%; P = 0.012). The CLABSI rate in the ICUs in the 6 months prior to the intervention was 1.90 cases/1000 CVC days. In the 6 months following the initiation of the dedicated team the rate dropped to 0.00 cases/1000 CVC days. This difference was not statistically significant. Fewer CLABSIs occurred in the ICUs and compliance to the CVC maintenance bundle increased following the initiation of daily audits by a dedicated team. Findings of the daily audits were communicated to nursing & nursing management daily.