Comparison of Blood Culture Contamination Rates and CLABSIs Following Implementation of CVC Needleless Connector Changes According to Manufacturer’s Guidelines

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Fall, Melissa
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Purpose: The purpose of this project was to determine whether changing the needleless connectors on central venous catheters (CVC) per manufacturer recommendations affects CLABSI and blood culture contamination rates for inpatient pediatric patients.|Background: Central venous catheters (CVC) place pediatric patients at a higher risk for central line associated bloodstream infections (CLABSI). In addition to CLABSI rates, a false-positive lab finding can occur from a contaminated blood culture draw. Initiatives have been implemented to help decrease CLABSIs and contaminated blood culture draws through the Joint Commission CVC maintenance bundle and Infusion Therapy Standards of Practice guidelines.|Sample/Setting: 70 full-time, part-time, and registry pediatric nurses. Target population includes all inpatient pediatric patients with a CVC for greater than 48 hours in a 30-bed combined PICU and general pediatric unit at the Children’s Hospital in a northwestern US state.|Methods: A quality improvement project with a pre/post study design was evaluated with descriptive statistics. Nurses received education on the new needleless connector change protocol. The needleless connectors were changed every seven days per manufacturer recommendations. CLABSI and blood culture contamination rates were compared pre/post the change the needleless connector change interval. Additionally, nurse adherence with the new practice change was evaluated by chart reviews in patients’ electronic medical records (EMR).|Results: During the 3.5-month intervention period, 34 blood cultures were drawn from a CVC with 0 (0%) CLABSIs and 0 (0%) contaminated blood cultures. Essentially, no difference was noted when compared to the previous years’ data. In 2017 and 2018 collectively, 508 blood cultures were drawn with 4 (.79%) CLABSIs and 3 (.59%) contaminated blood culture. Nurses documentation in the EMR suggested compliance with the new protocol.|Conclusion: The absence of CLABSIs or contaminated blood cultures suggests that the lengthened interval of changing the needleless connector can be incorporated into nursing practice; however, continued monitoring of CLABSI and blood culture contamination rates is warranted to maintain patient safety.
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