A Multidisciplinary Approach to Implementing Evidenced-Based Practice: Achieving Zero CLABSI in the Immunocompromised Cancer Patient

Purpose:
Utilizing evidenced based practice has reduced central line associated bloodstream infections in immunocompromised oncology patients on an inpatient unit to zero.

Relevance/Significance:
Prevention of central line-associated bloodstream infections is a 2015 national patient safety goal. Seventy percent of CLABSI are considered preventable. Neutropenic patients are highly susceptible to infections even from their own flora. Development of a CLABSI can result in high mortality, lengthy and costly hospital stays, line removal, delay in treatment, and compromise in cancer treatment outcomes.

Strategy and Implementation:
7 out of 9 CLABSI at a hospital were attributed to the inpatient oncology unit between 2009-2014. All of these cases were in neutropenic patients with an absolute neutrophil count of less than 1000. A quality initiative was developed by a staff nurse to improve patient outcomes through nurse education and implementation of evidenced based practice. A multidisciplinary approach was taken to involve patients, nursing staff, patient care technicians, management and director level nurses, infectious disease specialists, oncologists, massage therapists, IV team nurses, clinical nurse specialists, and a Magnet program director. Two measures implemented were use of neutral pressure caps on all central lines and daily chlorhexadine bathing of neutropenic patients. Compliance was tracked through chart auditing and data collected on every neutropenic patient with a central line admitted over the course of a year. A plan, do, study, act cycle was used to improve staff compliance.

Evaluation:
The unit has had zero CLABSI in over 16 months. Data was collected on 88 neutropenic patients with central lines. This included length of stay, admitting diagnosis, WBC count, protective isolation days, type of line, and cap used. The oncology unit has the highest central line days and usage in the hospital with 1704 central line days and 64% usage during the year that this data was collected.

Implications for Practice:
Infection can be dangerous and even deadly to the immunocompromised patient. Use of evidenced based practice with multidisciplinary involvement has resulted in decreased mortality rates, better treatment outcomes, less healthcare dollars utilized, and increased staff and patient awareness.