Presented at Ochsner Research Day, May 20, 2014
Jean Shiber MN, RN-BC, OCN , Gina Jolicoeur RN, OCN, Tere Crouchet MSN, RNBC, CCTN
Acute Oncology Unit, Ochsner Medical Center, New Orleans LA
- Central line-associated bloodstream infections (CLABSIs) is a costly problem that increases hospital stays and risk of mortality
- CLABSI is the second leading cause of death from a healthcare acquired infection in the US (Boubekri, 2013)
- The cost of caring for each CLABSI event is estimated $26,000 – $45,000 per case (Dumont & Nesselrodt, 2012)
- CLABSIs are preventable when proper management of the line occurs. Efforts to use bundle care recommended by the Center for Disease Control and Prevention have driven nation-wide improvement, but elimination of CLABSIs continues to be a challenge for many hospitals (Boubekri, 2013)
- There are four sources of central line contamination:
- organisms introduced during insertion
- contamination of the catheter hub which introduces bacteria into the lumen
- bacteria from another body site traveling through the bloodstream to the catheter
- contaminated infusate (Dumant & Nesselrodt, 2012)
- Nurses can be the driving force behind reduction in CLABSI rates through:
- Education and training of staff
- Hand hygiene and sterile technique
- Appropriate selection of catheter and site
- Use of devices such as chlorhexidine-impregnated dressings, preps, cuffs, catheters, and locks
- Leadership support
- Cultures of safety
- Availability of resources (Kusek, 2012)
- National guidelines do not yet endorse the use of dis-infection caps due to lack of clinical trials but state that future trials are needed (O’Grady, 2011)
- Out of 60 needleless ports using the disinfection caps, only 1 became contaminated (Menhay, 2008)
The aim of this project was to implement the use of disinfecting caps as part of the central line bundle to prevent CLABSI on an Acute Inpatient Oncology Unit.
October 2012- Staff was educated on the following:
- The disinfecting port protectors are luer-lock caps with an alcohol saturated sponge-like foam that cleans the catheter hub
- The port protectors disinfect three minutes after application and acts as a barrier up to seven days if not removed. Once removed, a fresh cap must be applied.
- Importance of hand hygiene, and patient education
Nov. 2012- Disinfection caps introduced on unit
Jan. 2013- Aug. 2013 Audits conducted to track cap compliance, central line care, and hand washing
- The compliance of using the disinfecting cap rose steadily to over 90%
- Compliance with central line dressing changes have sustained 100%, and hand hygiene varies reaching 80-90%
- CLABSIs rates have decreased on both the units
- Consider implementing daily goals checklist for Central Lines to reduce Central Line Days when possible
- Re-educate staff on entire central line bundle and monitor each step for compliance
- Perform CLABSI huddles for each occurrence to investigate which part of the bundle was not successful
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Brungs, S. M., & Render, M. L. (2006). Using evidenced-based practice to reduce central line infections. Clinical Journal of Oncology Nursing, 10(6), 723-725.
DeLa Cruz, R. F., Caillouet, B. & Guerrero, S. S. (2012). Strategic patient education program to prevent catheter-related bloodstream infection. Clinical Journal of Oncology Nursing, 16(1), 9-17.
Dumont, C. & Nesselrodt, D. (2012). Preventing CLABSI central line-associated bloodstream infections. http://www.nursing, (6), 41-46.
Kusek, L. (2012). Preventing central line-associated bloodstream infections. Journal of Nursing Care Quality, 27(4),283-287.
Menhay, S. & Maki, D. (2008). Preventing central venous catheter-associated blood stream infections: Development of an antiseptic barrier cap for needleless connectors. American Journal of Infection Control, 36 (10), S174.e1-S174.e.5.
O’Grady et al.. (2011). Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases,52(9), e162–e193.
Sweet, M. A., Cumpston, A., Briggs, F., Craig, M., & Hamadani, M. (2012). Impact of alcohol-impregnated port protectors and needleless neutral pressure connectors on central line-associated bloodstream infections and contamination of blood cultures in an inpatient oncology unit. American Journal of Infection Control, 40 (10), 931-934.