Mechanical Circulatory Support Driveline Infection Reduction through Nursing Quality Improvement

Abstract

Introduction Infection in patients with left ventricular assist device is a leading cause of morbidity and mortality resulting in increased risk for additional complications such as bleeding, thrombosis and stroke. The purpose of this quality improvement project was to reduce driveline infections through implementation of an evidence-based bundled dressing kit and education to nursing staff. Hypothesis Education of nurses and implementation of a standardized kit for driveline dressing changes will reduce driveline infection rates and improve nurse knowledge, satisfaction and confidence with infection prevention practices. Methods A multifocal intervention to improve standardization of care related to LVAD driveline care practices was initiated in 2018 on 5 nursing units. A multidisciplinary group contributed to creation of a driveline dressing kit. Nursing unit champions were identified and educated regarding driveline care knowledge and dressing change techniques. The institutional policy was updated to reflect new practices. In-person teaching and online educational videos were used to deliver education to nursing staff from the 5 units. A knowledge survey was used to test nursing knowledge immediately following the initial education and was repeated after 6 months to assess knowledge retention. Nurses were additionally asked to respond to questions regarding satisfaction and confidence with practice changes at the 6-month follow-up. Results An overall reduction in driveline infection rate from 35.7% in the 8 months prior to implementation of the DL dressing kit to 12.5% in the 8 months post implementation. Of the champion group, 26 nurses received 100% on their knowledge assessment. After in-servicing, 50% of floor nurses scored higher than 90% on their knowledge assessment. After 6 months, 57% of floor nurses scored greater than 90%. Of respondents, 93.6% agreed or strongly agreed that they “feel confident to expertly provide driveline dressing changes to LVAD patients using the new kit,” and 89.4% agreed or strongly agreed that they “feel confident that I can teach patients and their caregivers on how to use the new driveline dressing kit.” Conclusions While we have seen a great improvement in the rate of DLI, there are continued needs to reinforce nursing knowledge and skills related to driveline care and dressing change practices. Ongoing monitoring of driveline infection rates and further efforts to establish best practices are needed.