Date of Graduation

Summer 8-4-2026

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

David Ainsworth, DNP

Abstract

Problem: Central line-associated bloodstream infections (CLABSIs) are a significant source of preventable patient harm, increased healthcare costs, and prolonged hospital stays. In a 20-bed medical-surgical ICU, CLABSI events increased from one case in 2024 to four cases in 2025, resulting in a standardized infection ratio (SIR) of 1.21, exceeding the organizational target of ≤ 0.87.

Context: Audits of central line dressings identified frequent edge lifting and dressing disruption despite staff awareness of CLABSI prevention practices. These findings suggested a gap between evidence-based recommendations and consistent clinical practice. The project was conducted in a 20-bed adult medical-surgical ICU serving a diverse patient population. The nursing staff represented a wide range of clinical experience and backgrounds and shared a strong culture of high-quality, safe patient care.

Interventions: This quality improvement project standardized the use of gum mastic liquid adhesive (Mastisol) during central line dressing changes to improve dressing integrity. Staff education, stakeholder engagement, visual reminders, and supply management processes supported implementation. The project was guided by the Star Model of Knowledge Transformation and implemented using Plan-Do-Study-Act (PDSA) cycles.

Measures: The primary outcome measure was the CLABSI standardized infection ratio (SIR). Process measures included central line dressing edge lifting, Mastisol adherence, and nurse knowledge of Mastisol. The balancing measure was the occurrence of skin irritation or medical adhesive-related skin injuries (MARSI).

Results: From March through May 2026, no CLABSI events occurred in the ICU. At the time of writing, the official June 2026 Quality Dashboard was pending; however, preliminary information indicated no CLABSI events in June. If confirmed, the ICU would achieve a CLABSI SIR of 0.00, exceeding the organizational target of ≤0.87. Dressing integrity improved, with edge lifting decreasing from 41.7% to 29.4%; only one dressing (1.5%) was found to be completely detached during weekly audits and was promptly replaced according to unit policy. Staff knowledge of Mastisol increased from 78.9% to 96.7% and reported Mastisol use increased from 22.5% to 86.7%. No skin irritation or medical adhesive-related skin injuries (MARSI) associated with Mastisol or Detachol were reported during the implementation period.

Conclusion: Standardizing Mastisol use during central line dressing changes is a feasible, safe, and sustainable evidence-based strategy to improve dressing integrity and support CLABSI prevention. Integrating Mastisol into routine practice strengthens adherence to the central line maintenance bundle while promoting patient safety and professional accountability. Given its low cost and minimal workflow impact, this intervention has the potential to be sustained within the ICU and spread to other adult inpatient units caring for patients with central lines.

Keywords: Central line-associated bloodstream infection (CLABSI), intensive care unit, dressing integrity, edges lifting, gum mastic liquid adhesive (Mastisol), central line management, quality improvement, patient safety and evidence-based practice.

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