Interventions decrease incidence of catheter-related bloodstream infections

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An educational intervention designed to reduce catheter-related bloodstream infections (CR-BSIs) resulted in decreased infection rates that were sustained over time, results of a quality improvement process measuring the efficacy of such interventions have shown. Incidence of CR-BSIs in hematology and oncology inpatients are a high-priority concern: severe sepsis related to these infections can result in increased costs, morbidity and mortality, and prolonged hospitalization.

At the James Comprehensive Cancer Center at Ohio State University Medical Center, Columbus, Ohio, inpatient unit rates of catheter-related bloodstream infections were found to exceed comparable comprehensive cancer benchmarks, prompting observational audits and staff surveys, Susanne Vendlinski, RN, BSN, MSN, AOCN®, CNS, reported at the Oncology Nursing Society 36th Annual Congress.

Recognizing that catheter-related bloodstream infections is a nurse-sensitive outcome to address, gaps were identified, including knowledge deficit and practices inconsistent with institutional policy. One hypothesis was that central venous catheter (CVC) use was so commonplace that practice was routine and inconsistent, rather than intentionally aimed at infection prevention.

The unit staff development coordinator and clinical nurse specialist developed and facilitated an educational intervention utilizing self-study and hands-on skill performance, Vendlinski noted, with content based on institutional policy and current evidence. To promote participation and provide adequate time for personalized learning, sessions were scheduled on all shifts. Nurses and patient care associates completed self-learning packets that addressed their respective roles and responsibilities for CVC care and prevention strategies for catheter-related bloodstream infections.

Educational components included a pretest; review of posters, handouts, and competency checklist; return demonstration of CVC dressing change and line care; and a posttest. Facilitators present at the sessions provided feedback on competency skills performance and content application. In addition, signage was posted at each bedside to remind all staff, patients, and visitors of line infection prevention behaviors, which include proper handwashing, “scrub-the-hub” and access sites, and “tubing-off-the-floor.”

Following the educational intervention, an immediate, dramatic decrease in rates of catheter-related bloodstream infections was observed with an overall sustained downward trend. Vendlinski reported that one unit sustained 107 days of zero catheter-related bloodstream infections. Patient and family awareness of line care best practice was evident in comments that either acknowledged such a practice (ie, hub/access site scrubbing) or in reminding staff to perform best practices. Compared with similar units without posted signage, those with signage had showed reduced rates of catheter-related bloodstream infections.

The phenomenological finding of patient and family involvement in proper central venous catheter care suggests educating the patient and family may contribute to a sustained reduction and/or prevention of catheter-related bloodstream infections, Vendlinski concluded, recommending that further research is indicated to explore this potential benefit.
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