Title

Prevention of Central Line Associated Bloodstream Infections

 Problem Statement

Central lines can be very useful when administering several different

medications and fluids at once, especially when in the intensive care unit.

However, when a patient has a central line, it significantly increases the risk for

infection. The central line catheter provides bacteria with the opportunity to enter

the bloodstream and cause serious and sometimes fatal infections.

According to the Centers for Disease Control and Prevention (2011), central

line associated bloodstream infections (CLABSIs) are defined as serious infections

that occur when pathogens enter the bloodstream through a central line. These

infections cause thousands of deaths every year. The mortality rate for central line

infections ranges between 4% and 20%, with the average cost per CLABSI

reported around $45,685 per patient (Bakdash, Drews, & Gleed, 2017). However,

the incidence of central line associated bloodstream infections has decreased

significantly in the past 5 years. This dramatic decrease in the number of CLABSIs

can be attributed to the CLABSI bundle, which is a set of guidelines created by the

Center for Disease control (along with other organizations), which has been proven

to significantly decrease the incidence of central line infections.

The CLABSI bundle is the current standard of care when it comes to prevention

of central line infections. The bundle contains several different components

including checklists for the insertion, maintenance, and removal of central lines.
 For example, the checklist requires that central line catheters be inserted using

sterile technique and that a sterile dressing be placed over the insertion site. The

CLABSI bundle checklist also states that central line dressings be changed

immediately if they become wet or soiled. Some other recommendations include:

changing the IV tubing anywhere between 4-7 days, bathing patients with

chlorhexidine every day, and scrubbing the access port with alcohol before every

use.

Question to be explored

Are the components of central line bundle kits significant regarding a reduction in

infection rates of central lines?

Methodology

We searched PubMed and Medline for the term “CLABSI prevention” and were

able to find 433 articles which matched our search criteria. Of these 433 articles,

we chose 4 articles to read and summarize for this project. We chose these 4

articles specifically because they were the most pertinent to our research question.

We also chose these articles because the studies were conducted within the past 5

years, which makes the information obtained more relevant to our research.
 Summary with analysis of literature and conclusion

Implementation of central line-associated bloodstream infection prevention

bundles in a surgical intensive care unit using peer tutoring

This article was chosen because it was specific towards our topic but also had

plans to implement safer practices by providing a unique technique for

teaching nurses about the new protocol guidelines. The article’s question was

“Does implementation of CLABSI bundle kits using peer-tutoring help reduce

CLABSI infections in the hospital setting?” The purpose was to implement

an educational program about CLABSI bundle guidelines to strengthen

adherence to the new practice. In this study, some nurses were educated about

the protocol by administrators and then those nurses went on to teach the other

nurses. The rationale behind this was that learning-by-teaching was the most

effective way to retain the information and therefore reduce the incidence of

central line infections. In fact, this study was able to conclude that 90% of the

content of a specific subject was retained when a person tried to teach the

information to someone else (Park, Ko, An, Bang, & Chung, 2017). Research

was collected 9 months pre-intervention, 6 months during intervention, and 9

months post-intervention. After this time frame, the CLABSI rate was further

monitored for the next 3 years. The study had taken place in a 767- bed tertiary

hospital (antimicrobial resistance 2017) in a surgical intensive care unit. There

 were limitations on this study because it was not compared with another

facility and only measured a single hospital. The practicality could be taken

to other hospital sites with limited resources though. The results were that the

implemented peer-tutoring did help reduce CLABSI infections but it was not

sustainable.

Central line insertion bundle experiences and challenges in an adult ICU

(McPeake, Cantwell, Booth, & Daniel, 2012) wrote this article to address the

initial use of central line insertion bundles in an adult ICU. The authors address

concerns about patient health and financial cost when central line infections

impede the healing process. The purpose was to improve methods of central line

insertion in order to prevent central line associated blood infections. The study

took place on an ICU in an inner-city teaching hospital. The authors implemented a

‘Plan-Do-Study-Act’ cycle and hoped this would be a model for improvement to

help reduce CLABSI in the hospital care setting. The model used a checklist for

insertion for those assisting with CVC placement. There were three ways that

helped improve accuracy of data collection. First, the data collection was

incorporated into the daily goals worksheet. (McPeake, Cantwell, Booth, & Daniel,

2012). Second, the date collection was created to be simple by incorporating it into

routine patient charting and care planning. Third, if extra data needed to be

collected it was not too complicated or cumbersome on nursing staff. The results
were that when the checklist was adhered to, the rates of CLABSI went down

significantly. There were even moments in the ICU where the unit went 300 days

without CLABSI. There were difficulties with informing staff of new procedures

because of turnover rate and because of the high number of staff. The authors

recommended the use of central line insertion bundles to improve patient

outcomes.
 Articles cited

CDC. (n.d.). Checklist for prevention of central line associated bloodstream

infections. Retrieved December 1, 2017, from https://www.cdc.gov/HAI/

pdfs/bsi/checklist-for-CLABSI.pdf

Linder, L., Gerdy, C., Abouzelof, R., & Wilson, A. (2017). Improve supportive

care practices to reduce central line– associated bloodstream infections in

a pediatric oncology unit. Journal of Pediatric Oncology Nursing, 34(4).

Retrieved from http://journals.sagepub.com/doi/10.1177/1043454216676838

McPeake, J., Cantwell, S., Booth, M. G., & Daniel, M. (2012). Central line

insertion bundle: experiences and challenges in an adult ICU. Practice

Development, 123-129.

Melville, S., & Paulus, S. (2017). Impact of a central venous line care bundle

on rates of central line associated bloodstream infection (CLABSI) in

hospitalized children. Journal of Infection Prevention, 15(4). Retrieved

from http://www.sagepub.co.uk/journalsPermissions.nav

Park, S., Ko, S., An, H., Bang, J., & Chung, W. (2017). Implementation of

central line-associated bloodstream infection prevention bundles in a

surgical intensive care unit using peer tutoring. Antimicrobial Resistance

& Infection Control, 6(103). Retrieved from

https://aricjournal.biomedcentral.com/articles/10.1186/s13756-017-0263-3
Using Practice-Based Evidence to Improve Supportive Care Practices to

Reduce Central Line-Associated Bloodstream Infections in a Pediatric

Oncology Unit

An inpatient pediatric oncology unit in the Intermountain West has sought to

reduce the number of central line infections by implementing specific

protocols based on research that was conducted on their own unit. By doing

a five-year study, researchers were able to identify the specific pathogens

that were causing a majority of CLABSIs. In this specific patient population,

the most common pathogens were viridans group streptococci and

coagulase-negative staphylococci (Linder, Gerdy, Abouzelof, & Wilson,

2017). With this information, they were able to conclude the organisms

causing the infections were commonly found on the skin or from the GI

tract. Taking this into account, the project team created a 1-2-3 mnemonic

which reminded patients that they needed to take one shower, brush their

teeth twice, and get out of bed three times daily (Linder, et al., 2017). In

addition to this, patients also were required to have their linens changed

every day. The thought behind this was that by reducing the amount of

pathogens on the patient’s skin and surroundings, the risk of getting a central

line infection would significantly decrease. This protocol was implemented

in addition to the current CDC recommendations regarding central lines.

Data was collected by audits that were conducted randomly throughout the

study period. This specific study concluded that the introduction of the new

protocol significantly reduced the amount of central line infections. Before

the CDC bundles or new protocol was introduced, the total number of

CLABSI events was 156. With the implementation of the bundles alone, the

number of CLABSI events dropped to 44. Finally, with the addition of the

new protocol and the bundles, the number of CLABSI events decreased to

39 (Linder, et al., 2017). One significant limitation of this study is that it was

only specific to one unit in a pediatric hospital. However, one strength is the

amount of time that the study was conducted over.

Impact of a Central Venous Line Care Bundle on Rates of Central Line

Associated Bloodstream Infection (CLABSI) in Hospitalized Children

A study conducted at Alder Hey Children’s Hospital in Liverpool, England

yielded similar results, which further strengthens the validity of the current

practice related to this issue. This study also sought to lower the risk of

CLABSIs in patients. This study was over a period of three years, during

which researchers implemented a central venous line care bundle that was

very similar to the CDC care bundle. The central venous line care bundle

emphasized the importance of hand hygiene, catheter site inspection,

dressing, catheter injection ports, catheter access, and administration set

replacement (Melville & Paulus, 2013). More specifically, the bundle

required hand washing both before and after patient contact, hourly

inspections of the catheter site for signs of infection, maintenance of a clean

and dry dressing, scrubbing ports with alcohol prior to access, and the

replacement of the administration set per hospital protocol. Using an audit

system, the research concluded there was a decrease of over 50% in

CLABSI rates from the first year following implementation to the third year

of the study. This study was able to further confirm the efficacy of central

line bundle kits in reducing central line infection rates. One weakness of this

study is that it was also conducted on a very specific population in a single

hospital. However, a strength is that the data is very suggestive of the

practice being effective in the long run.

 Implications for nursing

CLABSI can affect patients in all areas of care but CVCs are mostly seen in an

ICU setting. Central lines are important tools used to give medicine, fluids, blood

products, or nutrition during their time of care in an ICU. It’s important to note that

the insertion and care of CVCs must be accomplished appropriately to prevent

infection. The results of our studies show that constant vigilance and awareness of

Central Line Bundles helps prevent CLABSI. Although many nurses may not place

a central line it is in a Nurse’s scope of practice to assess the lines and administer

medication, fluids, and clear minor blockages. This research helps change nursing

practices to prevent the occurrence of CLABSI and provide a safer healing

environment for patients. Any of these helpful charts, assessments, and policies

can help change nursing practice. Nurses are able to change policies based on their

evidence based practice to promote a better universal practice. Another implication

is that this skill can be taught as an orientation skill for ICUs.

Names and school

Courtney McComas & Erika Bell. Westminster College of Nursing.

Abstract

Title: Prevention Against Central Line Associated Bloodstream Infections

Problem Statement: Central lines are frequently used to administer medications in

the clinical setting. However, patients who have central lines have a significantly

higher risk for developing a serious bloodstream infection. The purpose of this

research was to determine whether or not central line bundle kits were effective

against preventing central line associated bloodstream infections.

Question: Are the components of central line bundle kits significant regarding a

reduction in infection rates of central lines?

Methods: We searched for our scholarly articles on PubMed and Medline. 433

articles matched our search criteria and out of these we chose 4 that were the most

relevant to our research topic. We then read each article and created a summary

and conclusion that addressed our original research question.

Outcomes: Overall, based on the articles we reviewed, the use of central line

bundle kits is an effective way to reduce the incidence of central line associated

bloodstream infections.