2021 Annual Conference

CNS Improving Outcomes
Quality Initiatives

Significance and Background: Although the volume of central line infections in the ICUs is higher, non-ICU units have been found to have central lines in place for prolonged periods, with reported rates ranging from 2 to 6 per 1,000 lines days. In 2019, our facility experienced higher than expected CLABSI rates and SIR, 1.055, with similar trends of events occurring on non-ICU units. This supports the need for interventions to improve central line utilization and maintenance practices in non-ICU environments where infrequent exposure has not allowed for adoptions of best practices.
Evaluation Methods: Recruiting an engaged team of CNSs, CNLs, and infection preventionists, a standardized audit tool was developed which evaluated evidence-based recommendations for prevention including disinfection of hubs, needleless connectors, and injection ports before catheter access; use of chlorhexidine skin preparation for skin antisepsis; and routinely changing transparent dressings every 5 to 7 days and gauze dressings every 2 days or whenever soiled, loose, or damp. An electronic audit tool and dashboard were created to store audits, monitor for trends, and readily share findings. Collaboration with educators to develop educational materials and with leaders to coach identified teams occurred.
Outcomes: Identified opportunities include inconsistent labeling of IV lines with expiration dates, variable placement of alcohol-based port protectors, variability in CHG bathing, insertion of ports not allowing 360-degree coverage with a CHG protective disk, and accessing ports without provider order. Each opportunity was addressed with real-time education, formalized sharing of best practices, and dissemination of formal education to heighten awareness of policy. Coaching was provided to specific individuals identified as being inconsistent in caring for central lines per policy. While data is still being finalized, both rates and SIR are showing positive preliminary trends.
Implications: Standardized maintenance teams have been identified in the literature as pivotal in decreasing line-rounding subjectivity and variability. A small, dedicated team who is able to take ownership of CLABSI reduction can decrease unit and facility-level CLABSI rates, as well as reduce length of stay and cost. Furthermore, auditing, real-time education, and coaching are pivotal in creating a culture of awareness around the importance of CLABSI prevention. Success can also be attributed to having the support of dedicated masters prepared nurses in CNSs and CNLs.