Line Alert! Central Line Bloodstream Infection Prevention

Purpose:
The goal of this project was to reduce central line associated bloodstream infections through instituting an evidence based bundle for maintenance and care of central lines on the progressive care unit of a community hospital.

Relevance/Significance:
Over 250,000 central line associated bloodstream infections occur in the United States annually. They are also associated with an increased risk of death and higher costs of care for hospitalized patients. The Centers for Disease Control and Prevention central line infection prevention guideline includes recommendations for sterile, dry, and intact dressings; for accessing devices only with sterile items; and for daily review of necessity and prompt removal of lines when indicated.

Strategy and Implementation:
In 2014, an evidence based care bundle for prevention of central line bloodstream infections was introduced to the progressive care team. Weekly audits were conducted for all patients on the census with triple lumen central catheters, peripherally inserted central catheters, implanted ports, dialysis catheters, and other central lines. Bedside nurses checked to determine if the central line dressing was occlusive without reinforcement, was dry and intact, and was labeled with date and time. The nurse also checked for labels on all IV tubing, and for presence of green alcohol-impregnated caps on any open IV access ports. Real time feedback was given to team members on opportunities for improvement. Nurses were also asked to document that a daily review of necessity was performed with the physician during rounds. Metric trends were shared with the unit practice council and posted on the unit quality board on a monthly basis.

Evaluation:
In January 2014, only 25% of audits reached 100% compliance for the entire care bundle. By December 2014, 85% of all audits achieved 100% compliance. All measures showed positive trends throughout the year. The most improvement was seen in compliance with alcohol-impregnated cap use, which reached 93% in December. The team did not have a central line infection for over one year.

Implications for Practice:
Bedside nurses engaged peers in central line bloodstream infection prevention through real time feedback on weekly audits of the care bundle. The project has actively improved the unit safety culture, and has proved feasible in a community hospital progressive care unit.