Development of protocol for reduction in central line associated blood stream infectionsSundermann, Alexander (2015) Development of protocol for reduction in central line associated blood stream infections. Master's Thesis, University of Pittsburgh. (Unpublished)
AbstractBackground: Central line associated blood stream infections (CLABSIs) are a highly expensive and deadly hospital associated infections (HAIs). Recent studies focus on reducing the CLABSI rate in both intensive care units (ICUs) and non-intensive care units. Each study focused on multiple aspects to reduce CLABSIs at the insertion of the line and the maintenance period, which is the length the central line, remains in place after the insertion. The results have shown there are many possible ways to reduce CLABSIs in the hospital setting. Objectives: The purpose of this study is to evaluate the effectiveness of an audit tool to assess the compliance of nurse documentation and bedside duties of central line care and maintenance in a University-affiliated tertiary care hospital. The implementation of this audit is expected decrease the hospital’s CLABSI rate. Methods: This study has two portions. The first is a prospective examination of nurse documentation and bedside practices for patients with central lines in ICUs and non-ICUs. The second portion is a retrospective analysis of documentation of patients that developed CLABSIs compared to those who did not develop a CLABSI. Results: All units increased compliance in 90.4% of documentation and bedside assessments. Weekly trends indicated increasing compliance as the audit period progressed. The retrospective analysis also revealed that daily line necessity (evidence that a patient still requires the central line in place) was not properly documented for patients that developed CLABSIs compared to patients that did not develop a CLABSI (n=621, OR=4.99, Fisher exact P=0.016). Conclusions: These results suggest initial success in increasing compliance by nurses and other clinicians providing care and maintenance of central lines. The retrospective analysis shows the importance of documenting daily line necessity in order to remove unnecessary central lines which may lead to infections. Future studies should be carried out to determine the cause of poor compliance. Public Health Significance: The audit used in this study reflects prior research shown to reduce the CLABSI rate. With further use of this audit, the CLABSI rate should be reduced which can be help decrease patient morbidity and mortality and decrease costs to the patient and hospital. Share
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