1. Demonstrate how nurses surpassed national infection control benchmarks using the Central Line Related Bloodstream Infection Bundle.
2. Describe how a nurse driven quality improvement project achieved and maintained success over a 15 month period.

Description: This poster will outline the process used for achieving successful quality outcomes in a general Intensive Care Unit.

Summary: Central line related bloodstream infections are estimated to occur in 3-5% of cases, are associated with an increased mortality rate of 10-20%, and prolong hospitalization by a mean of 7 days. Costs per infection can be as high as $29,000.00.  

The Centers for Disease Control have published guidelines for the management of intravascular catheter-related infections. This central line “Bundle” was subsequently endorsed by the 100,000 Lives Campaign. Upon routine surveillance at our institution, our infection control nurse specialist determined that the central line infection control data from our Intensive Care Unit was not meeting national benchmarking standards. Further, this nurse specialist discovered that staff was not aware of the central line bundle guidelines, and that central line practices were not consistent among ICU staff nurses. Using quality improvement strategies, a multidisciplinary team was formed. The team, which included bedside nurses, reviewed the literature, determined priorities, evaluated products, and developed a mechanism for implementing the full central line bundle. Implementation strategies included hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection, and daily review of line necessity.  Policies and procedures were amended to reflect the most current best practice standards. Staff education included mandatory completion of a central line bloodstream infection education module. 

Success of the project was measured by tracking intensive care central line infection rates. For the past 15 months, no central line infections have occurred in the ICU. Because of the tremendous success in the Intensive Care Unit, use of the central line bundle has been expanded to include all nursing units in the institution. To accomplish this, a community wide team was empanelled and the need for a standardized approach to line care was identified.

Implications for practice: Using a systematic approach to implementing practice changes and including bedside RN involvement with administrative support can result in quality standards that surpass national benchmarks.