Date of Graduation
Project/Capstone - Global access
Master of Science in Nursing (MSN)
School of Nursing and Health Professions
Problem description: Central line associated blood stream infection (CLABSI) is one of the deadliest types of hospital acquired infection and blood stream infection, raising patient mortality by 12-25% and accounting for 28,000 deaths annually in the United States. CLABSI also increases morbidity, length of stay, and costs hospitals an average of $48,000 per case. Effective measures for CLABSI prevention are needed for an adult intensive care unit (ICU) of an urban hospital to decrease the financial burden of CLABSI, improve quality of care, and prevent patient harm.
Setting: The microsystem of focus is a 36-bed high acuity ICU. Patients of this ICU are on average 51 to 65 years of age with the top three diagnoses being heart failure, liver failure, and transplant of mostly heart and liver. Thirteen CLABSIs occurred at this hospital since its opening in 2019. Counterproductive patterns regarding central line care were targeted for change, mainly focusing on lack of compliance in nurses following central line care policies.
Method: Thorough assessment, intervention, and evaluation of this quality improvement project was performed following the competencies of the clinical nurse leader. Clinical nurse leaders work within the interdisciplinary team of a nursing microsystem to integrate evidence-based practice into the clinical practice to improve patient outcomes and reduce costs.
Interventions: Peer-audit central line care assessment checklists were influenced by best practices associated with CLABSI prevention including effectiveness of interdisciplinary collaboration and consistent compliance in carrying out the interventions. A two-part educational intervention was developed to target unit-specific fallouts that could contribute to CLABSI incidence.
Results: Upon completion of this quality improvement project, fewer CLABSIs occurred during the first quarter of 2021 compared to that of 2020, with none occurring during the implementation phase of this QI project. The central line standard utilization ratio decreased, and documentation of central line dressing changes increased by 32.9%, which are outcomes tracked to assist in CLABSI prevention efforts. Post-intervention surveying indicated a 7.8% increase in nurse knowledge regarding the central line dressing change deadline.
Conclusion: This quality improvement project succeeded in increasing nurse compliance with performing and documenting central line dressing changes, which is a preventative measure against the development of CLABSI. Increased nurse knowledge about CLABSI prevention, central line care policy, and central line indications was also noted. These positive outcomes serve as a foundation for future CLABSI prevention initiatives to build upon.
Rangel, Jacenda Lee, "It’s Their Lifeline: Preventing Central Line Associated Blood Stream Infection in an Adult Intensive Care Unit" (2021). Master's Projects and Capstones. 1162.