“Stay Hooked Up”: An Evidence-Based Approach to Decreasing Port-a-Cath Bloodstream Infection Rates

Purpose:
Our goal was to decrease central line associated bloodstream infections on the Oncology Unit by at least 10% in 2011 and due to the overwhelming success of a 63% improvement we set our goal for a greater reduction of 75% for 2012.

Significance:
Central line associated bloodstream infections lead to an increased length of stay, increased morbidity, and can even cause death. With an increase in Port infections our purpose was to implement a practice to improve our quality outcomes for patient safety and decrease our infection rates.

Strategy and Implementation:
A multi-disciplinary team approach was utilized to research, perfect, and implement the “STAY HOOKED UP” initiative at the bedside. The team included clinical staff nurses, nurse educators, infection preventionists, physicians, and administrators. Research of evidence-based practice concerning the issues found in our case review was used as a guide to create new procedures and policy for the care of Port-a-Caths accessed during treatment. A comprehensive innovative plan which included staff education and hands-on competency was approved by the Infection Prevention and Performance Improvement Committees. The initiative was implemented in 2011 and went hospital wide in 2012. The focus was to limit the number of times the accessed port system was interrupted. This initiative was given the catchy “STAY HOOKED UP” title to make it easier for staff to remember the main objective. Initiative updates and the ongoing results were presented monthly to committee meetings.

Evaluation:
Our innovative practices over the past 2 years on the Oncology Unit reduced central line associated bloodstream infection by 85% from the start of this study in 2010 through 2012. The staff on the Oncology Unit demonstrated collaborative thinking, involving the patient in the process.

Implications for Practice:
Changing the culture was an important aspect of the success. Both the nurses and patients adapted to the routine of "stay hooked up" and created the opportunity to decrease the infection rates and evolve the standard of care to improve quality.