2021 Annual Conference

CNS Improving Outcomes

Purpose: This process improvement project was implemented to decrease Central Line-Associated Bloodstream Infections (CLABSI) on SCVMC 4-East PCU Oncology Unit where patients are in extreme risk due to high central line utilization rate.

Relevance/ Significance: Central line–Associated Bloodstream Infections (CLABSI) result in thousands of deaths each year and billions of dollars in added cost to the US healthcare system, yet these infections are preventable. Patients with cancer are more vulnerable to infection because of impaired immune competence due to their disease process or chemotherapy-induced neutropenia. This infection can result in significant morbidity and mortality, prolonged hospitalization and increased costs.

Strategy and Implementation:  A review of the CLABSI cases identified gaps in practices to include failure to comply with CDC recommendations preventing infection during insertion and management of central lines leading to the development of an evidence-based CLABSI prevention bundle. Strategies included staff education on the appropriate indications, line assessment, 2-RN dressing maintenance, CHG bathing compliance, appropriate line access for patency, oral care, hygiene practices, 2-RN lab draw, patient empowerment and ensuring compliance through daily self-audit and Daily Management System. Staff education was provided using the Peer-to-Peer Knowledge Exchange (P²KE) Tool for a period of one month.

Evaluation/Outcomes:  71% percent reduction in total number of CLABSI from 7 in CY 2018 to 2 in 2019 and maintains at zero for 2020.

Implications for Practice: Prevention of CLABSI is a team effort involving all healthcare disciplines, patients and families. Nurses are at the center of person-centered care and are in the best position to assure that CLABSI prevention recommendations are incorporated into practice.