Despite being preventable, central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and cost the U.S. healthcare system billions of dollars. Infection is a common problem in patients with cancer, particularly those receiving chemotherapy and radiation.
At one hospital, the medical oncology inpatient unit had a quarterly standardized infection ratio (SIR) above 1.0 for six quarters in 2015 and 2016 (SIRs higher than 1.0 reflect more infections than anticipated). The CLABSI rate on the medical oncology unit was among the highest in the hospital (2.31) when researchers initiated an intervention to reduce the SIR rate. They found that increasing awareness of CLABSI prevention and ensuring that equipment was available, stocked, and being used correctly significantly reduced the number of infections. Glenda L. Kaminski, PhD, CNS, AOCN®, CRNI, presented the results in “Reducing Central Line Associated Bloodstream Infections in Patients With Cancer” as part of the e-poster sessions on November 2 and 3 during the 2018 JADPRO Live conference in Hollywood, FL.
The intervention focused on five areas of perceived need:
- Patients were educated on their increased risk for infection, notable symptoms to report, and ways to prevent infections.
- Central line supply levels were adjusted to meet daily needs.
- A neutral pressure connector was used for valved peripherally inserted central catheter hubs. No connector was attached to the hub, which allowed for direct catheter exposure when changing tubing or drawing lab specimens.
- Staff were education on the development of a hands-on show-and-tell box with all central line equipment and standardization of tubing and dressing change dates and documentation, and the standard operational policies were updated.
- A daily chlorhexidine bath was provided for all patients with central lines.
The action plan was implemented between October 2016 and December 2017. Now central line infections were reported for three of the six quarters during the intervention, and the SIR dropped to 0.62 for quarter one of 2018.
As part of program follow-up, the clinical nurse specialist continues to monitor central lines at least twice weekly in patients’ electronic health records and once weekly in rounds, and charge nurses and other RNs audit central lines several times per month.
“The clinical nurse specialist plays a significant role as expert clinician, consultant, and change agent in the prevention of hospital-acquired infections, leading to cost savings for the organization and best outcomes for the patients,” Kaminski concluded.