Central lines are lifesaving devices but can be linked to approximately 250,000 central line-associated blood stream infection (CLABSI) cases annually in hospitals across the United States.
Fortunately, CLABSI is preventable through a proactive approach that involves identifying
and addressing the unique risk factors for CLABSI in each hospital setting. (DaVita).
A Central Line is a thin hollow tube often inserted into a vein in a patients’ neck/chest/groin to administer medications, for medical tests and for many other reasons. Colonization of germs around Central Lines may occur either externally from the skin puncture site, or internally from intraluminal bacterial spread from a contaminated hub resulting in serious and life threatening complications for patients (Alkilany, 2016, p2).
All hospital-acquired infections are tracked and trended through the Department of Infection Prevention and Control. The number of CLABSIs more than doubled at Penn Presbyterian Hospital especially in the MICU in 2013.A root cause analysis showed poor Central line handling and maintenance by personnel/nurses as well as inconsistent and variable documentation.
As part of preventative efforts, a checklist has been developed for the Penn Presbyterian observers to use while observing the staff during central line activities, and also to implement this checklist in their routine central line activities. This consisted of a systematic guide to CDC and evidence-based practices to prevent CLABSIs. Evidence-based practice includes using sterile technique when preparing to access or de-access the CVC, hub scrubbing with an appropriate antiseptic and hand hygiene (Penn Medicine, 2016).
A key element in the prevention of bloodstream infection is nursing care and maintenance of the central line dressing. All nursing staff was re-educated on the proper way to change a central line dressing.
The central line dressing kit was enhanced to include two masks instead of one to ensure both the patient and the nurse wore masks during the dressing change. The chlorhexidine gluconate cartridge was replaced with three chlorhexidine gluconate swabs, which are more effective and also more user friendly. The competency also included education on the proper use of chlorhexidine gluconate swabs and the proper application of the Bio-patch.
Evidence based practice has shown significant improvement in reducing CLABSI through the implementation of a CLABSI safety tool. This tool will not only decrease mortality and morbidity among patients, but will also decrease the burden on the Unit and the hospital in general treating this type of hospital acquired infection.