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Two Person Dressing Change Team to Prevent Central Line-Associated Bloodstream Infections (CLABSI) in a Stem Cell Transplant Unit at a Tertiary Medical Center
Abstract   Open access   Peer reviewed

Two Person Dressing Change Team to Prevent Central Line-Associated Bloodstream Infections (CLABSI) in a Stem Cell Transplant Unit at a Tertiary Medical Center

Shannon Hunger, Kristen Van Scoyoc, Tacia Bullard, Mary Beth Kukla and Mary Beth Davis
Biology of blood and marrow transplantation, Vol.26(3), pp.S82-S82
03/2020
DOI: 10.1016/j.bbmt.2019.12.040
url
https://doi.org/10.1016/j.bbmt.2019.12.040View
Published (Version of record) Open Access

Abstract

Stem Cell Transplant (SCT) patients are at high risk for Central Line Bloodstream Infections (CLABSI). These infections may result in extended length of stay, increased cost, CMS penalty, and death. Care and maintenance of Central Venous Lines (CVL) is an oncology nursing practice. In 2017 SCT unit nursing staff acknowledged concern for unit CLABSI rate along with reports of practice variation. Literature, guidelines, and best practice were collected. Through collaboration with institution healthcare professionals these nurses identified a potential practice change. The purpose was to evaluate if implementation of a 2 person (CVL) dressing change team would reduce CLABSIs on the SCT unit of a tertiary medical center. We selected the Iowa Model Revised- Evidence Based Practice to Promote Excellence in Health Care© along with the Quality Improvement Model, DMAIC, to guide our change process. Four nurses were trained and worked to standardize workflow and maintain sterility throughout the CVL dressing change. In addition, a supply cart and standardized day were established. All patients with a CVL on the SCT unit were included. The outcome, CLABSI rate, was conducted utilizing the National Healthcare Safety Network (NHSN) CLABSI manual, internal focused reviews, and observations of care and maintenance of the CVL by Nursing Practice Leaders and an Infection Preventionist. Implementation of a 2 person (CVL) dressing change team led to a 78.3% non-MBI CLABSI reduction on the SCT unit of a tertiary medical center 1 year following implementation. This standardized personnel/workflow/day of the week procedure also improved central line stewardship by patients. These findings are novel to the literature. Implications of these results have led this team to disseminate their work with other areas of the institution and share externally. Pivotal to the success of the 2 person dressing change team was continued focus on CLABSI prevention bundle by other healthcare team members. It is recognized that variations to workflow may need adjusted to fit needs. Continued investment to the CLABSI prevention bundle and standardized workflow is beneficial to the SCT nursing practice.

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