A Nurse Driven Strategy to Significantly Impact Central Line Infection Rates

Purpose:
The PICC Team was initially established to place lines in the inpatient and outpatient setting across the age continuum. The purpose of this strategy was to utilize an already established, highly effective, team to decrease CLABSI at a 531-bed, ANCC Magnet designated, academic teaching facility.

Significance:
Bloodstream infections represent 14% of all Healthcare-associated infections (HAIs. Up to one in four patients die from CLABSI. There are approximately 41,000 CLABSIs in acute care hospitals costing up to $2.7 billion in the US annually. CLABSI are costly, deadly, and largely preventable.

Strategy and Implementation:
The PICC team strategized methods to decrease CLABSI while maintaining PICC line productivity and outcomes with minimal fiscal resources. The team began with a pilot in the Medical/Surgical Intensive Care Unit to determine dressing changes; development of a computer generated daily report indicating all active central line and dressing status; establishment of a mobile cart; and enhancement of documentation to more clearly identify the type of dressing and access. After the pilot was complete, the process was implemented house wide. Additional strategies were identified including: monitoring femoral lines; "scrub the hub"; cap protectors; hand hygiene education; and policy revisions. A nurse driven process by clinical experts in the area of vascular access can lead to successful patient outcomes that can easily be replicated in peer organizations.

Evaluation:
CLABSI numbers in 2010 were 39. After project implementation, numbers decreased to 8 in 2011 and 4 in 2012. Year to date in 2013 there have been no CLABSIs. Nurse satisfaction scores increased housewide and all four members of the PICC team achieved board certification in vascular access.

Implications for Practice:
Expanding the scope of a traditional PICC team to include oversight of CLABSI clinical outcomes can drastically improve patient outcomes in a short time frame. Central line report monitoring and daily assessments empower nurses to collaborate with physicians to implement and sustain best practice.