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.
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.
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.
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.