Using Active Learning Methodology to Improve CLABSI Rates in the Adult ICU

Purpose:
The adult ICU saw an increase in the central line associated blood stream infection rate to 8.06/1000 device days from April 2008-August 2008. The strategic goal was to reduce CLABSI by engaging the team, helping to foster learning, and thereby improving the care of the patient with a central line.

Significance:
Healthcare-associated infections impose significant patient and economic consequences. The adoption of evidence based practice (EBP)in the clinical setting is paramount to improving patient outcomes. There are many barriers to the adoption of EBP in the bedside clinical setting.

Strategy and Implementation:
The innovative approach of active learning methodology was utilized to allow the direct care nurses to be active participants in the acquisition and dissemination of new knowledge related to central line infections. A group of interested nurses were brought together and, with the leadership of the clinical specialist, they learned how to search for literature to defend their practice. They developed a data collection tool and pretest to collect baseline data, then analyzed that data to come up with education for their peers in several different media. Teaching points were shared on a weekly basis with posters and pictures of correct techniques in the care of central lines along with peer-to-peer hands-on competency using a model from an old IV practice arm, an IV bag, and a PICC. CLABSI data obtained from the monthly infection prevention reports as well as the quarterly NDNQI report was used for root cause analysis of all CLABSI's in their perspective units(CV,med-surg,neuro/trauma).

Evaluation:
Pre/post test results indicate that nurses' knowledge was improved by education. Knowing that adult learners need to know the relevance of their behavior change, benchmarking using NDNQI CLABSI rates was important. CLABSI rates in ICU have continued to decrease to 1.18/1000 device days (YTD 4/2010).

Implications for Practice:
By assisting a small group of nurses to develop leadership/teaching skills, an active learning approach helps engage direct care nurses in new knowledge acquisition. Some barriers to adoption of EBP can be overcome by the use of this approach leading to better patient outcomes.