Decreasing CLABSI by Increasing Central Access

Purpose:
Our ICU had a significant increase in central line related blood stream infections in 2014. Our team evaluated the process we used to care for patients with central lines, including insertion, care and maintenance of the central line.

Relevance/Significance:
The nurses in ICU determined the process changes which may be needed to improve our outcomes. These changes were related to the way we cared for our patients with central lines. The intervention described in this abstract show improvement in patient care. Nurses were engaged in the identification and solution to the issue, which improved patient safety and quality care for our patients.

Strategy and Implementation:
Evidence demonstrates the more a central line is manipulated, the greater the potential for infection. The nurses identified an increase in the number of continuous infusions, antibiotics and blood products requiring central access. On the most critical patients, the number of infusions was usually more than four. As new medications, antibiotics or blood product administration were added, the nurse needed to manipulate the current and new infusions to ensure compatibility. This was happening up to 6 times per shift. With this realization, the nurses met with the medical director to request a short term central line and PICC to decrease central line manipulation. Currently, our nurses will request secondary central access when peripheral access is difficult and multiple medications need to be given. The Intensivist will insert a short term central line and order a PICC. As the patient improves, the nurse will remove the short term central line and continue with the PICC.

Evaluation:
Since problem identification and intervention we have decreased our CLABSI rate to zero for the past 4 months. The nurses report they are much more efficient in providing patient care with additional lines for infusing multiple medications. The time they were spending on determining compatibility and re-arranging medications can now be used providing patient care and family support.

Implications for Practice:
It may seem counter-intuitive to add a second central access when trying to decreased central line infections. However, we were able to demonstrate, when managed appropriately, our infections rates actually decreased.