Intentional Collaborative Rounds Focusing on Eyes on the Lines: A CLABSI Reduction Project

Abstract

Background : Prevention of central line-associated bloodstream infections (CLABSI) is critical to reducing prolonged hospital stay, cost, and preventable deaths. Despite the use of evidence-based practices (EBP) for the care and maintenance of a central line (CL), reducing CLABSI is a daunting task and carries broad effects for the health care system. This project examined the relationship of intentional collaborative rounds (ICR) on EBP for care and maintenance of a CL in a cardiovascular intensive care unit (CVICU). The aim of this project was to assess for missed CL care and maintenance interventions, identify barriers to implementing these practices, and recommend solutions to reduce CLABSI rates. Methods : ICR were conducted on a 13 bed CVICU in a tertiary care, academic hospital located in the Midwest. A checklist was used to assess compliance of EBP on the care and maintenance of a CL. Results of the assessments were shared with bedside nurses and displayed on a Pareto chart for staff to review. Results : The ICR intervention resulted in improvement for each of the nine EBP components used in the care and maintenance of the CL when comparing from baseline to the project's end. Intact CL dressings and proper placement of the chlorhexidine gluconate (CHG) disk as part of the EBP recommendations were particularly problematic. To overcome these barriers, an updated CHG impregnated dressing was recommended by infection prevention nurses and a new product pilot was incorporated into the ICR project. Findings from the new CHG dressing pilot showed improvement in the dressing not intact (p Conclusions : Using a structured approach such as ICR to identify barriers, supports the work to move evidence into practice, serves as a vehicle for sharing best practices, and ultimately reduces CLABSI rates.