CLABSI REDUCTION: IMPROVING DRESSING COMPLIANCE

AUTHORS:

VICKIE GRIFFIS, MSN, RN, CCRN AND ANITA “GAIL” CANTRELL, ABC, EF, GHIJ

As a member of the Adult Vascular Access Team (AVAT), who performs daily rounding and surveillance on all central lines every day, we noticed a trend. As we rounded and found a breached dressing, we kept hearing similar responses from the bedside staff. “I knew you guys would be rounding, so I just saved the dressing for you to change.” And then more frequently, “I haven’t done a central line dressing in quite a while; I’m just not comfortable doing it.”

As this was occurring more and more, we decided it was time to act. Recognizing their lack of confidence and competency in performing a dressing change, an opportunity for quality improvement presented itself. At this moment in time, our central line dressing compliance was at 87.4%, and the central line bloodstream infection rate was 0.90/1000 catheter days.

Therefore, an opportunity was knocking. INS Standard: 42.3. Site Care, including skin antisepsis and dressing changes, is performed at established intervals and immediately if the dressing integrity becomes compromised (e.g., lifted/ detached on any border edge or within the transparent portion of dressing; visibly soiled; the presence of moisture, drainage, or blood) or compromised skin integrity is present under the dressing 1

We decided to initiate this Quality Improvement (QI) Project with 2 primary goals.

1. Improve dressing compliance rates-

• Nurses would be educated on how to assess dressings and determine if a dressing was breached.

• Nurses would be educated on how to perform a central line dressing change appropriately.

2. Decrease central line-associated bloodstream infections (CLABSI).

Our steps in the planning process included:

• An Action Request was submitted to Shared Governance to propose a practice improvement in which the bedside nurse will change a breached central line dressing as soon as possible. The action request was sent to the Practice Council for review. This request was approved.

• A subcommittee then met to discuss potential interventions and actions to address the problem. From this meeting, the importance of hands-on training became apparent and was preferred.

• The team leaders, Vickie Griffis and myself met to discuss how the education would be completed. This education would include the rationale for this project, current compliance rates, and a demonstration of a central line dressing change done by AVAT.

• The team leads then met with the management teams of the floors on which we focus our education to discuss plans and goals.

• Education began in April 2022.

Conclusion

We are a year into the QI project and have completed approximately 60% of the targeted audience. We have seen positive results with increased compliance and decreased CLABSI rates. As we continue with the project, we hope to see further positive impacts at our facility and better outcomes for our patients.

(I am assuming that the numbers here are 0.0X/1000 catheter days, please explain the chart here for the reader. You discuss these two charts in the narrative to explain what the reader is looking at. For example, you could mention in your 2 main goals that the team set a minimal compliance rate goal of 90% and how you measured compliance. Then in a narrative, when you discuss your current success and refer the reader to (Figure 1). Similarly, you could explain Figure 2 in the narrative so the reader understands how these numbers are generated.)

References

1. Gorski LA HL, Hagle ME, et al. Infusion therapy standards of practice. J Infus Nurs. 2021;44(1):S119 doi:10.1097/NAN.0000000000000396

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