“Scrub the Hub” Reducing Central Line Associated Bacteremias in a Bone Marrow Transplant Setting

Purpose:
To minimize central line infections in a high-risk,immunocompromised, critically ill patient population and to consistently remain below the NDNQI national mean CLAB rate benchmark for Magnet Hospitals and all Hospitals.

Significance:
There is a high incidence of mortality associated with central line and blood stream infections in bone marrow transplant patients. As nurses, our role is to promote patient safety and minimize patients' risks. We are empowered to improve patient outcomes by utilizing best practices.

Strategy and Implementation:
Our unit experienced 5 CLABs in the first 3 months of the quarter of FY09, a variance of more than 400% from FY08. All cases were reviewed and no trends were found related to pathogen, physician or line site. Accurate and proper line care became the multidisciplinary focus. Intense observations of line care revealed three issues that may have led to the increased CLAB rate: staff failing to wipe the hub consistently, staff not allowing Chlorhexidine to dry, and dressings repeatedly found not adhering to the skin. Immediate action was taken to remedy the identified matters. The multidisciplinary team met with the nursing staff to discuss current trends, issues, and best practice. The nurses initiated a “Scrub the Hub” campaign and the manager and coordinator monitored all nurses performing line care for proper technique. In October 2008 the IV Team observed all central line dressings for proper technique and nursing staff was required to complete an online IV education module.

Evaluation:
FY08 CLAB rates: July 8.13 August 2.27 Sept 4.54 Oct 1.94. After the implementation of best practice, a dramatic, sustained reduction in CLAB rates was achieved. The unit has been CLAB free since November 2008, significantly below the NDNQI mean for all Hospitals and Magnet Hospitals.

Implications for Practice:
Successful quality initiatives always start with evaluating current practice and end with implementing solid evidence-based practice. Peer accountability; continued commitment to “scrub the hub” and daily monitoring is key. The nurses are especially proud of zero CLABs for 19 months.