Decreasing CLABSI Rates and Cost Following Implementation of a Disinfectant Cap in a Tertiary Care Hospital

Abstract

BACKGROUND/OBJECTIVES: Central line blood stream infections (CLABSI) are responsible for significant patient morbidity and costs. One prevention method is using a standardized approach to disinfect needleless connectors. Nurses, however, struggle with compliance to this recommendation, leaving patients with central lines vulnerable to infection. Further, some research suggests that manual disinfection may be insufficient to disinfect heavily contaminated connectors. The purpose of this implementation research study was to describe nurses compliance to disinfection of needleless connectors and determine the effect of a disinfectant cap on the rate of CLABSI and contaminated blood cultures. We hypothesized that nurses were not adequately disinfecting connectors and implementation of a disinfectant cap would decrease CLABSI and contaminated blood cultures. METHODS: Nurses in a large tertiary care hospital were given a baseline survey to describe their current needleless connector disinfection practices. In January 2012, a disinfectant cap was implemented for all central and peripheral needleless connectors in all inpatient departments (excluding womens services). Education included vendor teaching or on-line modules on the use of the cap. The nurses also completed a required on-line module on proper blood culture drawing techniques. Weekly compliance of the disinfectant cap was reported to the nurse managers.Just in time educationwas given to staff during the audit process including proper care of the secondary tubing set. Rates of CLABSI and blood culture contamination were compared before and after implementation. RESULTS: Baseline data revealed that 55% of nurses scrub the needleless connector < 5 seconds. There was a significant increase in compliance to the disinfectant cap from the beginning (M1⁄473%, SD1⁄415.6) to the end of the study (M1⁄488% SD1⁄45.8) (t (42)1⁄4 -4.19, p1⁄4 .01). There was a significant decrease in the rate of CLABSI per 1,000 line days before implementation (M 1⁄42.4%, SD 1⁄41.5) and after implementation (M1⁄4.87%, SD 1⁄4 .63) (t (68) 1⁄4 3.19, p 1⁄4 .02). There was a non significant decrease in the rate of contaminated blood cultures before (M 1⁄4 2.5%, SD 1⁄4 .45) and after (M 1⁄4 1.4%,SD 1⁄4 .32)