Purpose/Objectives:
To address the need to reduce the rate of catheter-related bloodstream infections (CRBSI) in the critical care population.
Significance:
A final rule published by the Centers for Medicare and Medicaid Services (CMS) states that hospitals will not receive additional payment for patients with hospital-acquired infections. This change necessitates that hospitals work quickly to implement evidence-based guidelines to move infection rates as close to zero as possible.
Design/Background/Rationale:
The rate of central venous catheter (CVC) infections was at an all time high in all critical care units of the institution. In order to improve quality of care, this project addressed implementation strategies for the CDC guidelines and IHI bundles to reduce the infection rate related to CVCs in the adult and pediatric critical care units of the institution.
Methods/Description:
The Institute for Healthcare Improvement (IHI) central line insertion and maintenance bundles, Centers for Disease Control and Prevention (CDC) guidelines for dressing changes, and use of a chlorhexidine gluconate (CHG) impregnated patch were implemented using Rosswrum and Larabee's (1999) model for change to evidence-based practice. Program participants were all critical care patients in our hospital having a non-tunneled central venous catheter (CVC). Data collection included microbiology and hematology lab data and clinical indicators. Results were reported as the pooled mean rate of infection as compared to the national benchmark.
Findings/Outcomes:
CVC infections were reduced in all participating critical care units.
Conclusions:
This project demonstrated that catheter-related bloodstream infections (CRBSI) can be reduced in the critical care unit if an evidence-based guideline is utilized for catheter insertion and a dressing change regimen is implemented that includes the use of a CHG patch.
Implications for Practice:
Implementing new innovations will improve quality of care for patients in critical care. While nurses may initially see changes as time-consuming, they will quickly move to acceptance as they understand the reduction of work in other areas due to improved quality of care.
Section Description
The journal is proud to share the student abstracts accepted for poster presentation at the 2009 National Association of Clinical Nurse Specialists Conference. These abstracts are submitted under a separate later deadline and therefore did not appear in the journal with the general abstracts. Congratulations to these CNS students and their faculty mentors.