This was a passion project of mine. 🤗
First and foremost is my passion for one of the authors. I am so proud of her accomolishments. 👰🏼👩🏼🎓
Sis, this was all you - I was just along for the ride. 👒
Thanks for opening my mind to these concepts, patiently teaching me these skills, for giving me the confidence to believe that I can learn to understand medical research and for always supporting my dreams. 👩🔬👩🏻⚕️
It was an homor to participate in a project to protect patient safety and promote evidence based practice.
Love you always and forever! ❤
First and foremost is my passion for one of the authors. I am so proud of her accomolishments. 👰🏼👩🏼🎓
Sis, this was all you - I was just along for the ride. 👒
Thanks for opening my mind to these concepts, patiently teaching me these skills, for giving me the confidence to believe that I can learn to understand medical research and for always supporting my dreams. 👩🔬👩🏻⚕️
It was an homor to participate in a project to protect patient safety and promote evidence based practice.
Love you always and forever! ❤
Central Line Maintenance Care Bundle and CLABSI Rates
Michelle Morginstin, Bat-Sheva Polishuk, and Maeve Wynne
Decker School of Nursing, Binghamton University
Central Line Maintenance Care Bundle and CLABSI Rates
In both inpatient and outpatient settings, central lines are used to provide long term venous access (Haddadin & Hariharan, 2019). A central line associated bloodstream infection (CLABSI) is defined as “a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of a central line placement” (Haddadin & Regunath, 2019, p. 1). Further, It is estimated that 250,000 bloodstream infections occur each year in the United States (Haddadin & Regunath, 2019). CLABSIs can lead to sepsis and potential death (Haddadin & Hariharan, 2019). An estimated 28,000 individuals die from CLABSIs each year in the United States (Haddadin & Hariharan, 2019).
The Practice Problem
Multiple nurses at Hospital A expressed concerns over not being equipped with the proper tools and knowledge to reduce the prevalence of CLABSIs. The need for CLABSIs to be the topic of this quality management project was further evidenced after comparing the rate of CLABSIs in surgical wards in Hospital A to its state benchmark. Hospital A is located in New York State (NYS), and the rate of CLABSIs in its surgical wards is 1.7, while NYS’s benchmark for CLABSIs on a surgical ward is 0.76 (NYS Department of Health, 2017). Hospital A’s CLABSI rate is more than two times the state’s benchmark for surgical wards, which is why it was selected to be the subject of this evidence-based quality management project. CLABSIs are an outcome problem because outcomes are quality measures that determine the result of care, or what the effect of the intervention was on the patient (Marquis & Huston, 2017).
The Institute for Healthcare Improvement (IHI) recommends a central line bundle made up of evidence-based interventions for the care and maintenance of central catheters (2012). Moreover, the key evidence-based interventions of the central line bundle are “hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection, and daily review of line necessity with prompt removal of unnecessary lines” (IHI, 2012, p. 8). Multidisciplinary teams are ideal for implementing central line bundles (Walz et al., 2015). Teams made up solely of nurses may be successful, but without physician engagement, they often lack the leverage needed to make critical changes (IHI, 2012). It is also important to gain buy-in for CLABSI prevention interventions from the chief executive officers of hospitals, because this gives the project the visibility and credibility needed for its success (IHI, 2012).
Reducing CLABSIs would be extremely cost-effective for Hospital A. On average, they extend hospital stays by a week, costing up to $46,000 to treat (Haddadin & Hariharan, 2019). They top the list as the most expensive healthcare associated infection (Haddadin & Hariharan, 2019). Not only are CLABSIs costly to treat, but hospitals are increasingly being denied reimbursement for these costs by third-party payers (Calderwood et al., 2018). Furthermore, from a cost-benefit perspective, it is feasible for Hospital A to implement a central line maintenance bundle. When using a cost-benefit analysis, if the benefits are greater than the costs, “the project or intervention is then considered worthwhile” (Bergmo, 2015). In terms of central line maintenance bundles, the benefits far outweigh the costs. Benefits included in the Joint Commission’s analysis of central line bundles included decreased morbidity and mortality (2012). Although it is difficult to quantify the cost of implementing interventions such as the CDC’s central line bundle, the Joint Commission insists that it is far less costly to prevent CLABSIs than to treat them (2012).
Nursing Practice Innovation and Literature Review
The tremendous value of implementing an evidence-based central venous access device (CVAD) maintenance bundle is demonstrated in the medical and nursing literature. These bundles include a set of standardized procedures proven to lower the risk of CLABSI, along with education programs and a commitment to bundle compliance (Perin et al., 2016). Ista et al. conducted an international systematic review and meta analysis that showed a “significant reduction in the CLABSI incidence...p<0.0001” (2016, p.729) and increased cost savings (2016). Further, they stated that “the incidence of infections decreased significantly from median 6.4 per 1000 catheter-days...to 2.5 per 1000 catheter-days...after implementation of bundles” (Ista et al., 2016, p.724). Likewise, Pertin et al. stated that their systematic review revealed “significant results concerning decreased central line-associated bloodstream infections after the implementation” (2016, p.8) of bundles. Lastly, Entesari‐Tatafi et al. found success with implementing a CVAD maintenance bundle in their institution, with “the average CLABSI rate [falling] from 2.2/1000 central line days...during the pre-intervention period to 0.5/1000 central line days...during the post-intervention period” (2016, p.247).
The evidence-based central line maintenance bundle utilized in this project is as follows: daily evaluation of current need for the central line and subsequent removal if deemed unessential, daily chlorhexidine gluconate (CHG) body bathing, all needleless access valves are covered by alcohol impregnated caps, a sterile dressing change every 7 days, including a biopatch or CHG impregnated dressing, and a nurse-lead, peer education program for all staff, including proper hand washing and sterile technique, the importance of scrubbing the hub for at least 15 seconds before using needleless access valves, and the importance of bundle compliance to accomplish success. Furthermore, this bundle was developed to be implemented in Hospital A to address many of the facility’s nurses’ concerns. When asked about the hospital’s elevated CLABSI rates, many nurses stated that they wished the hospital had more up-to-date CLABSI prevention policies. They also expressed desire that Hospital A stock alcohol-impregnated caps. Upon further investigation, we discovered that the hospital’s CVAD maintenance policy only requires nurses to perform a sterile dressing change weekly with a biopatch and perform proper hand hygiene.
All of the above bundle elements were shown to decrease the incidence of CLABSI in successful bundles or individual studies. The study conducted by Entesari‐Tatafi et al. (2016), that saw a significant reduction in their CLABSI rates, included a daily evaluation of the need for the central line. This action ensures that only patients who truly need the invasive line will continue with this treatment. Intravenous (IV) access into a large vein is a considerable potential portal for infection and decreasing the unnecessary use of these lines will greatly decrease infection rates. Further, CHG bathing is used to prevent any bacterial growth on the patient’s body. Using either chlorhexidine gluconate infused wipes or wash daily kills any bacteria on the skin and prevents recolonization for 24 hours after washing (Frost et al., 2018). According to Frost et al., the use of CHG bathing decreased the incidence of CLABSI by 40% in their systematic review (2018). Next, using alcohol impregnated caps on all needleless access valves “decreases colonization of microorganisms on the connectors and thereby lowers the risk of CLABSIs” (Voor in ’t holt et al., 2017, p.34). This prevents any passive growth of bacteria and their entrance into the central line. Additionally, using these caps offsets many nurses’ noncompliance with ‘scrubbing the hub’ for at least 15 seconds by decreasing the amount of growth on the hub, making their minimal scrubbing more effective (Voor in ’t holt et al., 2017). Similarly, sterile dressing changes, with chlorhexidine wash, kills any existing microorganism growth and prevents future growth. Azar et al. conducted a study in which they significantly reduced their CLABSI rates (2019). Their bundle included “changing dressing (transparent dressing with or without chlorhexidine: every 7 days)” (Azar et al., 2019, p.35). The dressing change in our study will also include applying a new Biopatch, infused with chlorhexidine, or a chlorhexidine-impregnated dressing to the insertion site to prevent bacterial growth and entrance into the wound (Entesari‐Tatafi et al., 2016).
Lastly, the study intervention will include a nurse-lead, peer education program for all staff, including providers, nurses, and ancillary personnel, to ensure proper technique and adherence to the bundle. According to Park et al., “implementation of CLABSI prevention bundles using peer tutoring...was useful and effectively reduced CLABSIs” (2017, p.1). Through peer tutoring, Park et al. were able to reduce their CLABSI rates from 6.9/1000 infections in the pre-intervention period to 2.4/1000 in the intervention and 1.8/1000 in the post-intervention period (2017). Further, Perin et al. stated that their “study emphasized that the role of the nurse as a leader of the multi-professional team was key for the success of interventions” (2016, p.6). Almost all of the above cited studies included hand hygiene, sterile technique and bundle compliance emphasis or education; furthermore, Azar et al. stated it the most clearly. Their curriculum included “bundle adherence as stipulated by the guidelines, sterile technique…, hand hygiene, and central line maintenance” (Azar et al., 2019, p.35). Additionally, the education program will include techniques to properly disinfect needleless access valves before medication administration by ‘scrubbing the hub’ with alcohol wipes for at least 15 seconds. According to Caspari et al. (2018),
Recent laboratory (nonclinical) studies of antiseptic scrub times for catheter hubs found
that 3- to 5-second alcohol scrubs were not sufficient to decontaminate hubs and that a
minimum of a 15-second alcohol scrub with friction is needed to effectively sterilize
needleless access ports. (p.1)
This study showed that education statistically increased staff’s time scrubbing by at least 12 seconds (p<0.002) (Caspari et al., 2018). Finally, bundle compliance will be emphasized in the education program. Perin et al. stated that “only when compliance with a care bundle is high, is it associated with reduced rates of infection” (2016, p.6). Moreover, a study conducted by Hakko et al. accomplished a 0% CLABSI rate in their institution for 38 months after the implementation of their bundle. They identified that CLABSI rates are indirectly associated with compliance rates and that “encouraging a culture of patient safety in the hospital with behavior changes and adaptation of health-care workers” (2015, p.296) was their key to success.
Quality Management Model
The organizational framework of Hospital A consists of numerous vice presidents/ directors of different areas within the hospital who report to the president/chief executive officer, who reports to the board of directors for the hospital. Quality improvement projects are carried out through the quality management department with its director’s approval, and in this instance, would also include the infection control department because this project deals with CLABSIs. In addition to having the approval of the quality management director and the infection control department, there are other organizational committees that the quality improvement project needs to pass through to ensure implementation. The policy and procedure committee would need to review and be on board with the new procedures for central line care included in the bundle. Similarly, the nursing education committee would need to be included so as to help roll out the peer education program for all staff included in the bundle. Additionally, the financial department and purchasing personnel need to be consulted to ensure the attainment of the supplies the bundle necessitates such as alcohol impregnated caps, biopatches, and materials required for the daily CHG bath. Furthermore, the bundle needs to be approved and supported by the chief nursing officer and all of the inpatient unit managers, as the bundle implementation is not possible without them.
Plan Do Study Act is the quality management model used at Hospital A. It is a “four-stage problem-solving model used for improving a process or carrying out a change” (Minnesota Department of Health, 2016). During the “plan” stage, the goal of reducing the rate of CLABSIs by implementing a central line maintenance bundle was chosen, and a plan was developed to implement the bundle (Minnesota Department of Health, 2016). Additionally, during the planning stage, the bundle’s five objectives were developed. The objectives are as follows:
- At least a 5% decrease in central line infections after implementation at Hospital A in December 2020, according to hospital data.
- After the peer-led central line care education class, in December 2020, nurses will self-report being 15% more confident in their ability to verbalize two reasons why daily evaluation of central line need decreases infection risk.
- In December 2020, after the peer-led central line care education class, nurses will self-report being 15% more confident in their ability to verbalize two reasons why the use of alcohol impregnated caps helps to decrease central line infections.
- In December 2020, there will be a 10% increase in the number of nurses who self-report scrubbing the hub of the IV line for at least 15 seconds.
- At least 60% of nurses will self-report report being compliant with the central line bundle.
While Hospital A did have guidelines in place regarding CLABSI care, they were not up-to-date with evidence-based practice, and many staff members reported not knowing that such guidelines existed. A clear need for an up-to-date CLABSI bundle that included staff education was evidenced. During the “do” stage, the CLABSI prevention bundle was implemented, CLABSI data was collected, and any problems or new ideas that came up were documented (Minnesota Department of Health, 2016). In the “study” stage, the data was analyzed and the effectiveness of the bundle in reducing CLABSIs was evaluated (Minnesota Department of Health, 2016). The “act” stage included revising and modifying the bundle in order to restart the cycle and continue improving central line care (Minnesota Department of Health, 2016).
Since repeat surveying of nurses’ practices was not feasible during the current pandemic, data collection methods had to be adjusted. To inform the need for the development of the bundle, since an initial survey was not possible, both national and state level CLABSI infection rates were used. However, after bundle implementation, nurses will be completing a post-intervention survey. The content of the survey can be seen in Figure 1 in Appendix A. Some questions require nurses self-report their behavior before and after the intervention, which allows for a measurement of the impact the intervention made. The results of this survey will provide the data necessary to evaluate whether or not certain objectives were met.
Data Collection
The infection control department in Hospital A noted that the CLABSI rate in the surgical ward is 1.7 CLABSIs per 1000 days, which is significantly higher than the 0.76 CLABSIs per 1000 days benchmark set by the NYS Department of Health for surgical wards (2017). According to The Center for Medicare and Medicaid Services, Hospital A will not be reimbursed from Medicare or Medicaid for the additional medical treatments and extended length of stay that are associated with CLABSIs (Calderwood et al., 2018).
To further understand the seriousness and prevalence of this issue within the wider healthcare system, we looked for information from the NYS Department of Health handbook, "Hospital Acquired Infections in New York State, 2018." According to the handbook, there were a total of 1,051 CLABSIs during an accumulative 1,294,898 days of central line use, which can be analyzed as an overall rate of 0.81 infections per 1,000 central line days in selected ICUs and wards. This number was drastically lower than the CLABSI rate from 2015, which was 1.123 infections per 1,000 central line days (NYS Department of Health, 2018). Considering this data, overall the CLABSI rate across the state was reduced by 24% from 2015 to 2018 during this time period. Specifically, it was reduced from 1.23 infections per 1,000 central line days in 2015 to 0.853 infections per 1,000 central line days in 2018 (NYS Department of Health, 2018). Moreover, this demonstrates a trend of declining CLABSIs across the board. However, the rates reported are still much too high considering the ideal goal is to prevent CLABSIs completely, a standard that has been proven achievable through the literature and evidence based studies (NYS Department of Health, 2018).
Data and guidelines from the Center for Disease Control and Prevention (CDC) can provide the clarity needed to understand CLABSI prevention at the national level. The CDC reports that a 46% decrease in CLABSIs has occurred in hospitals across the United States from 2008-2013, but an estimated 30,100 CLABSI still occur in intensive and surgical care units and wards of acute care facilities each year. While there is a documented reduction of CLABSIs, more work must be done to ensure patient safety and optimal health outcomes, considering that CLABSIs are life-threatening infections that prolong hospital stays while increasing costs for the patient and hospital (CDC, 2020).
The Post-Intervention Survey seen in Appendix will be given to nurses on each unit that participated in the project. Each nurse will be given the survey in an envelope by their nurse manager, and they will have a week to turn it back in. It is an anonymous survey, and the data gathered from it will allow for the evaluation of the project’s objectives. The survey was made anonymous in an effort to promote accurate self-reporting by the nurses included.
Planned Change
Change is an essential component in implementing evidence-based measures in nursing. Leading change can be challenging for nurses amongst all the other complexities and challenges of the evolving health care environment (Wojciechowski et al., 2016). Kurt Lewin, a known pioneer in the study of group dynamics and organizational development, theorized a three-stage model of change that included unfreezing, changing, and refreezing (Hussain et al., 2018). Lewin constructed this model in order to identify and examine the factors that influence a situation (Hussain et al., 2018). Lewin’s Change Theory is relevant to the central line maintenance bundle intervention because it provides a roadmap of how the change, or bundle, will be implemented. The unfreezing stage includes recognizing the need for improved central line care and the potential benefits this change could provide for the patient and hospital (Hussain et al., 2018). Next, the movement or changing phase occurs when the proposed change is implemented after passing through the previously discussed organizational channels and committees. The central line care practices are changing to those required by the maintenance bundle. Refreezing, the final stage, occurs when the central line maintenance bundle practices are reinforced and become the new norm (Hussain et al., 2018). The bundle will be utilized in its full capacity and cemented into the staff’s practice. The refreezing stage attempts to ensure that the change will be permanent (Hussain et al., 2018).
Forces of Change
There are several driving forces involved in the successful implementation of the central line care bundle. However, there are also counter forces that restrain the movement of this process. Furthermore, one driving force is that the Federal and State Departments of Health provide critical incentives to mandate the reduction of CLABSI. The guidelines indicate sincere effort towards infection control, in addition to the requirements from other licensing bodies that govern the administration and operation of the medical facility (Herzig et al., 2015). Likewise, there are many health insurance companies that have policies denying reimbursement to hospitals in the event of CLABSIs and other healthcare-associated infections. Moreover, the costs then come out of the hospital's budget (Woodward et al., 2016). As reported by Woodward and Umberger, “hospitals are now facing extrinsic pressures to keep their CLABSI rates low; otherwise, they may experience a 1% reduction in Medicare reimbursement" (2016, p.1). Another driving force is the potential for financial gain by decreasing the length of stay, as well as morbidity and mortality rates. These factors will also increase the hospital’s marketing ability, for example, in patient recruitment, promotional ratings, and social status within the healthcare community (Mcquillen et al., 2017). Next, government entities and insurance companies, involved in decision making regarding patient transfers, base these transfers on infection, morbidity, and mortality rate data (Calderwood et al., 2018). These entities reward hospitals with superior data with increased patient transfers, leading to increased revenue. Furthermore, hospitals with low CLABSI, morbidity, and mortality rates will be awarded benefits and gain increased social status within the medical community (Woodward & Umberger, 2016). This will include: invitations to speak at conferences, awards from civil societies and charitable organizations, and recognition from government and non-governmental organizations (NGO). Low CLABSI rates can provide a morale boost for the entire medical staff, because they will feel the impact of working for a professional system with high standards of excellence and see their patients recover and thrive (Woodward & Umberger, 2016). Staff morale and pride will in turn have positive effects on staff retention and recruitment.
Unfortunately, there are several restraining forces that must be overcome in order to achieve success regarding adherence to the central line bundle. For instance, most of the bundle protocols are not based on the hospital’s current practices, so staff might resist making changes in their practice. Moreover, potential unknown outcomes can cause liability for the hospital. The risk inherent in making any changes is a factor to be considered (Raveesh et al., 2016). For example, in Dumpa et al.’s 2016 study to reduce CLABSI rates in a level 3 neonatal ICU, one of the interventions implemented was to change the catheter care line. It was changed from interlinkin to clearlinken. However, there was an increase in CLABSI rates during that time period, which resulted in harm to some patients (Dumpa et al., 2016). Another restraining force is the hospital budget. These budgets are restricted by the limited amount of resources available for allocation. Deciding what to include in regards to procurement can be a difficult decision to make (Edwards et al., 2017). Additional equipment is needed for the central line bundle, such as an increased number of alcohol swabs, alcohol impregnated caps, and CHG bathing wipes (Kristensen et al., 2016). Subsequently, implementing this bundle may require additional staff for its development and training. The salaries of these additional staff members may put a strain on the financial department. Finally, with any change, there comes a certain amount of pushback and conflict. This can be further complicated by the pre-existing interpersonal conflicts present in many workplace environments (Shah, 2017).
Provision of Staff Training
It is imperative that the infection control department is on board with the plan, in order to implement the change. They need to be aware of the problem, and recognize why the changes included in the bundle are critical for patient safety. According to Lewin’s Change Theory, all parties involved should buy-in, in order to replace the current system (Wojciechowski et al., 2016). Widespread organizational support will facilitate the implementation of the bundle’s new protocol (Wojciechowski et al., 2016). Additionally, the infection control department will be the mediator in obtaining the financial department’s approval for the purchase of additional equipment. It is critical that infection control department members be eager partners in this plan, not merely passive participants.
A nurse-led, peer education program will be held for all staff, new and old, including providers, nurses, and ancillary personnel. This program will ensure proper technique and adherence to the bundle. Such programs are shown to be effective methods for adult learning (Lee et al., 2018). Moreover, the peer education program will be composed of a structured one hour lab, once a week, for five weeks. There will be fifteen staff members training at once. The staff will be provided with training videos on hand hygiene, the correct method of ‘scrubbing the hub,’ which is at least 15 seconds, how to use the alcohol impregnated caps, and how to maintain sterile technique. Additionally, the sessions will include hands-on activities to practice various aspects of the bundle. The staff will form groups of two or three to work on their central line care skills. There will be a nurse educator in charge of the lab, available to provide support and answer any questions. Peer learning has been shown to be an extremely effective method for learning new clinical skills (Ravanipour et al., 2015). For this bundle, nurses will teach each other how to correctly perform activities such as hand hygiene, sterile dressing changes, and how and when to use the alcohol impregnated caps. This intervention was found to decrease CLABSI rates in an intensive care unit (Park et al., 2017). Finally, all staff will be required to attend a short lecture taught by the infection control department, to introduce the hospital's new bundle. All clinical education and nursing training will be in-service training, as it has been proven to be the most beneficial and have the most successful outcomes (Chaghari et al., 2017).
Recommendation for Adoption
We recommend that Hospital A adopt the intervention as described. We do not advise modifying the bundle, as a CLABSI rate of zero is attainable. Slight alterations can cause infection and prevent the hospital from achieving this goal (Erdei et al., 2015). Furthermore, there are many rationales for the implementation of this protocol. Extensive studies have proven a strong correlation between CLABSIs and patient morbidity and mortality (Dumpa et al., 2016). Thus, it is critical to have nurse involvement in the implementation of this protocol. Providing the nursing staff with the appropriate equipment and training will ensure their ability to comply with the evidence-based methods necessary for patient safety and infection control (Ikwueme, 2018). Cooperation from all departments can foster the environment of motivation and respect needed to achieve a multidisciplinary approach towards central line care. As an agent of change, the student nurse has the opportunity to step up as a patient advocate and further the quality of nursing practice through utilizing best practices and new knowledge. The evidence and literature cited in this study should be presented to the executive staff, administration, and hospital leadership, to be used as part of their efforts to help problem solve and enhance practice (Ikwueme, 2018). Moreover, the intervention of all bundle elements is essential to prompt a higher quality of care. Training and education to promote a culture of safety within all departments is a critical first step in developing a multidisciplinary approach to prevent CLABSI occurrence (Ikwueme, 2018). The initial financial investment required to adopt the plan as recommended will be worth it in the long run, due to the overarching decrease in CLABSIs and costs associated with hospital-acquired infections (Calderwood et al., 2018). Ultimately, healthcare professionals take an oath to do no harm regardless of any financial concerns. The nurses and the medical facility are mandated to do all in their power to prevent illness and promote the health and well being of those placed in their care (ANA, 2015).
Evaluation
It is anticipated that the central line maintenance and education bundle will be highly effective, as it is modeled after successful bundles, some of which even saw 0% CLABSI rates after implementation. We foresee at least a 5% decrease in central line infections after implementation at Hospital A in December 2020, according to hospital data. Furthermore, after the peer-led central line care education class, in December 2020, we anticipate that nurses will self-report being 15% more confident in their ability to verbalize two reasons why daily evaluation of central line need decreases infection risk. Similarly, in December 2020, after the peer-led central line care education class, we anticipate that nurses will also self-report being 15% more confident in their ability to verbalize two reasons why the use of alcohol impregnated caps helps to decrease central line infections. Moreover, in December 2020, we expect to find a 10% increase in the number of nurses who self-report scrubbing the hub of the IV line for at least 15 seconds. Lastly, we forecast that at least 60% of nurses will self-report report being compliant with the central line bundle. The self-reporting data used to validate the acceptance of certain objectives will be drawn from the Post-Intervention Survey presented in Appendix A.
Because the project’s objectives are expected to be met on time, the central line maintenance bundle can be considered a success. Further studies may be needed on how to best maintain the reduced CLABSI rate. Perhaps periodic education classes may be necessary to keep practice in line with the bundle. These classes would also ensure that new staff are provided with the education required to provide proper central line care.
Conclusion
The cue to action for this quality management project was that multiple nurses at Hospital A felt ill-equipped in terms of the supplies and education necessary to properly care for central lines. Following this discovery, national and state data regarding CLABSIs was gathered and analyzed. Both nationally and within NYS, CLABSI rates have significantly dropped (CDC, 2020). While it is promising that the numbers show movement in the right direction, there are still an estimated 30,100 CLABSIs per year nationally (CDC, 2020), and Hospital A had more than double the NYS benchmark for CLABSIs in its surgical wards in 2017 (NYS Department of Health, 2017). This data, along with the fact that Hospital A’s nurses were not aware if their hospital had central line care guidelines, further evidenced the need for this project.
There is a plethora of evidence-based practice research regarding the successes central line care bundles have had in reducing CLABSI rates. However, as seen in Hospital A, practice has failed to catch up to the research. The fact that best practices are not being used is a true disservice to its patients. CLABSIs result in longer hospital stays, increased costs, and most importantly, increased morbidity and mortality (Haddadin & Hariharan, 2019).
Current evidence-based practice research was combed through and synthesized to develop the central line maintenance bundle used for Hospital A. Knowledge of Lewin’s Change Theory was used to inform and implement the bundle, as was the Plan Do Study Act quality management model. The central line maintenance bundle used in this study included elements that are proven to decrease or eliminate CLABSIs. The bundle met its objectives and was able to successfully reduce the rate of CLABSIs, which decreases costs for the hospital and its patients.
Conducting this project led to a broadened knowledge base regarding not only CLABSIs and their prevention, but also how quality improvements are made in hospitals. The necessity of support from the organization and its channels and committees to implement this project was increasingly evident as the project progressed. The political and administrative side to quality improvement was showcased in an entirely new way. It is the hope of this project that CLABSI prevention methods continue to be studied and that practice increasingly stays up to date with the research. As nurses, it is our duty to share the knowledge learned from creating and implementing this CLABSI bundle with future coworkers and administrators in an effort to encourage and facilitate the use of evidence-based practice to improve patient outcomes.
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Appendix
Figure 1
Post-Intervention Survey
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