SAN ANTONIO, Tex.–Formation of a multidisciplinary team and a focus on evidence-based interventions successfully reduced the rate of central line bloodstream infections (CLABSI) on an inpatient oncology unit, a study presented at the ONS 41st Annual Congress has shown.1
“CLABSI is associated with treatment delays and sepsis-related death in oncology patients,” said Lauri Brunton, RN, OCN, a clinical resource nurse at University of California, Davis Medical Center in Sacramento. “Infection prevention is paramount to the immunocompromised patient population and nursing is directly involved in this endeavor.”
In January 2015, the rates of CLABSI on the Hematology/Oncology/Stem Cell Transplant Unit at Davis Medical Center were well above the National Healthcare Safety Network (NHSN) benchmark. Temporary line infection rates were approximately 7 per 1000 line days and permanent line infection rates were nearly 4 per 1000 line days. The HNSH standard is 2.0 per 1000 line days.
Therefore, to address the issue, a multidisciplinary team consisting of 5 clinical resource nurses, the unit manager, an infection preventionist, and a quality and safety champion was created.
“We looked at our patient bathing protocol and environmental cleaning as practices that we could improve,” Brunton noted. An environmental sterility report of their wash basins showed true pathogen growth in 26% of basins.
Various interventions were implemented on the unit to reduce CLABSI rates, including: the use of 2% CHG wipes for all patients; the immediate discontinuation of wash basins, soap, and water for bathing; education about efficacy and importance of daily CHG bathing for nurses and physicians; a video demonstrating use was shown to nursing; and placing posters demonstrating proper use as visual aids in each room.
“We also requested that each nurse document CHG bathing/room disinfection, which was added to the Professional Exchange Report,” Brunton added.
Further, ambulatory patients were instructed to use the wipes after showering, which allowed the CHG to dry on the skin as recommended, whereas bed-bound patients received daily baths using the CHG wipes. Warmers were used to provide a more soothing application.
Following implementation of these practices, the temporary line infection rate and permanent line infection rate was 1.63 and 3.13 per 1000 line days, respectively. The investigators also observed a reduction in preventable CLABSI from an average of 3.5 infections in quarters 1 and 2 of 2015 to 0 infections in quarter 3.
“I am also happy to report that in March 2016, we had 0 CLABSI,” Brunton concluded. “The impact of these changes could dramatically change the course of recovery for these patients.”
1. Brunton L, Sawhill V, Mahr N, et al. Reducing CLABSI on an inpatient oncology unit by implementing evidence based hygiene practice. Oral presentation at: 2016 Oncology Nursing Society Annual Congress; April 28-May 1, 2016; San Antonio, TX.