Line Stewardship and Maintenance: A Quality Improvement Initiative to Decrease CLABSI on a Blood and Marrow Transplant Unit
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Authors
Schroeder, Mary Beth
Issue Date
2022-05-12
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Abstract
Purpose: The purpose of this quality improvement initiative was to decrease the rate of CLABSI on a Midwest blood and marrow transplant (BMT) unit through the implementation of a bundle approach focusing on standardization of nursing practices surrounding central line management.|Background: CLABSIs have been deemed a ‘never event’ by the CMS for all hospital units (Patient Safety Network, 2019). In particular, CLABSIs are a high risk and high-cost safety event for on particular subset of the oncology population- blood and marrow transplant patients who receive care in the hospital, due to the degree of immune compromise these patients experience. Despite a focus on CLABSI prevention, in 2020, one Midwest BMT unit had 14 CLABSI events, a significant increase from previous years.|Sample/Setting: The bundle was implemented on a 30-bed Midwest blood and marrow transplant unit and applied to all patients admitted with a central line. 69 audits were completed over the 8-week implementation period.|Methods: A bundle was developed surrounding central line management and followed patients admitted to the BMT unit with central lines. The bundle included measures to standardize central line cares such as standardizing dressing change days, implementing use of CHG wipes daily, and use of a 15 second scrub with alcohol wipes prior to each line access (CDC, 2011). The two-phase project evaluated staff education, compliance with bundle components, and CLABSI rates over the three months following bundle implementation.|Results: Following RN education, overall compliance with bundle practices was 89.6%. Overall, in the three months following implementation of the bundle, the unit had zero CLABSI incidences compared to two incidences in the three months prior to implementation.|Conclusion: Practice implications include a demonstration of bundle compliance as a viable tool to decrease CLABSI rates even in high-risk populations.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University