An Interprofessional Approach to Improving Central Line-Associated Bloodstream Infections

Purpose:
Learn how an interprofessional, collaborative approach resulted in implementation of a “No Central Line Blood Draw” process on an acute care unit. Successful outcomes in central line infections rates, laboratory sampling errors, and blood stream infections are reported.

Relevance/Significance:
The risk of introducing microorganisms into a central line access device increase every time the device is accessed or manipulated. Prevention of nosocomial infections requires a systematic, multidisciplinary approach, which usually can be achieved under the leadership of an institutional infection-control program.

Strategy and Implementation:
An interprofessional approach between nurses, physicians, vascular access team, infection control and phlebotomy was needed to improve the management of laboratory sampling for patients with central line devices. The team reviewed infection rates, central line days and access rates in order to develop a standardized process. They determined care outcomes could be improved by eliminating blood draws from central lines and a “No Central Line Blood Draw” process was implemented. This process change required redesign of physicians' ordering, restructure of phlebotomy and nursing workflow; competency validation for nurses related to central line blood draws, and patient/family education. Each patient with a central line is evaluated, and lab specimens are bundled and drawn peripherally by only phlebotomy or nursing staff. Special training on central line blood draws and capillary specimen collection was provided. A visual process flowchart was created as a guide for all staff.

Evaluation:
Since October 2014, the unit has had zero central line infections, which is a decrease from 2.99 central line infections per 1,000 central line days. The number of times central lines were accessed decreased from an average of 6 to 1.4 times per day, and lab error rates were eliminated. Physician ordering of STAT labs was reduced, and increased bundling of multiple laboratory specimens occurred.

Implications for Practice:
Implementation of an innovative process has improved infection rates and decreased the risk of transmitting nosicomal infections. Because of the successful outcomes, the process has remained as a gold standard practice and is being evaluated for hospital wide rule out in the acute care areas.