Implementing a Program to Standardize Central Line Maintenance

Abstract

<h3>Background</h3> Central line-associated bloodstream infections (CLABSI) significantly impact patient outcomes and hospital reimbursement. CLABSI mortality can be ≥25% and cost ∼$45,814/each. In 2017, our 394-bed acute care facility identified 15 hospital-wide CLABSI, revealing opportunities for improvement with central line (CL) maintenance. The project goal was to implement standardized tools and training to decrease CLABSI. <h3>Methods</h3> A CLABSI Task Force identified a program that focused on assessing current policies, practices and dressing change kits, and implementing standardized training. In March 2018, baseline CL maintenance assessments; policy gap analyses; and dressing kit evaluations were completed. Nurse performance of four key elements were evaluated: dressing changes, blood draws, medication administration and hub maintenance. Policy and dressing change kits were revised, with ensuing education. A "train-the-trainer" model was adopted, with 30 Unit Champions (UC) instructed to the new dressing change kits and standardized checklists of the four components. Each UC agreed to train "x" number of nurses in their unit within 30 days. Following training in March 2019, post assessment was conducted. Pre- (Jan 2017-Aug 2018) and post-implementation (Sep 2018-Oct 2019) CLABSI standardized infection ratios (SIR) were compared using National Healthcare Safety Network (NHSN) analyses. The study included adult and neonatal inpatient units, except Rehab. <h3>Results</h3> CLABSI events decreased from 15 to 7, and CLABSI SIR noted non-statistically significant decreases (0.93 to 0.67; p=0.4815), subsequent to program completion. Post-assessment revealed key improvements to CL maintenance including: hand hygiene, site preparation and hub disinfection. <h3>Conclusions</h3> Gap analysis of existing practices, policies and supplies, with standardized training, can lower CLABSI rates, and decrease SIR. Policy aligned to best practice and functional CL dressing kits position nurses for success in effective CL maintenance. Standardized training eliminates practice gaps and reduces CLABSI risk.