Oncology Nursing Society Congress

Validation of Nursing Skills Improves Central Line Infection Rates on HSCT Unit

Avatar photoJoyce Pagan
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Nurses discuss a patient’s case history.
A project to reverse an increase in CLABSIs on an HSCT inpatient unit and its ongoing impact were described at the Annual ONS Congress.

Oncology nurses play a primary role in reducing central line-associated bloodstream infections (CLABSIs), and staff education and consistent re-evaluation ensures continued proper chlorhexidine gluconate (CHG) treatment use and central venous catheter (CVC) practices. These findings were presented at the 47th Annual Oncology Nursing Society (ONS) Congress.

Patients undergoing hematopoietic stem cell transplantation (HSCT) are susceptible to central line-associated bloodstream infections (CLABSIs). A CLABSI is an infection that develops in a patient with a central line that cannot be attributed to any other probable cause. Contributing factors include long-term CVC placement and use, high-dose chemotherapy, prolonged immunosuppression, and posttransplant complications such as graft-vs-host disease.

A significant increase in CLABSIs on a 16-bed HSCT inpatient unit at an academic medical center prompted a thorough interdisciplinary root-cause analysis of each event. However, no attributing factors were found so the focus shifted to nursing practice as a probable cause for the increase in CLABSIs.

A quality-improvement project was initiated to reduce CLABSI incidence by 20% within 3 months of implementation, explained Therese Roselli, BSN, RN, OCN®, a nurse clinician at New York-Presbyterian Weill Cornell Medical Center. The intervention was a collaboration between HSCT unit nurses and nursing leadership to develop competency tools to validate skills in blood culture and lab draws via CVC and CHG treatment process.

All HSCT unit nurses were validated on central line management practices via the competency tools. To ensure consistency of validation, 3 nurses were designated and trained to complete all competencies.

Peer-to-peer validation revealed that 35% of the nurses did not follow hospital policy when obtaining blood cultures and blood draws from central lines and 66% did not know how to perform CHG treatments correctly. Feedback on efforts to improve these skills was provided in real time.

In 2020, the infection rate was 0.51 CLABSIs per 1000 central line days. But in the immediate preintervention period from January 2021 through May 2021, the infection rate had increased to 2.82 CLABSIs per 1000 central line days. The intervention was implemented in June 2021, and from implementation through August 2021 the CLABSI rate declined to 0.9 per 1000 central line days. This was a 68% decrease in CLABSIs within 3 months, exceeding the goal of the project.

In conclusion, Roselli named 3 components that ensured the project’s continuing positive outcome: collaboration between health care-associated infection (HAI) champions, nursing leadership, and nursing support staff; opportunities taken to mitigate risks (eg, hand hygiene, aseptic technique, blood culture technique, flushing technique); and adherence to recommendations for maintaining staff competence such as continuing peer-to-peer validations, real-time feedback, and HAI champions on all shifts.

Read more of Oncology Nurse Advisor‘s coverage of the 47th Annual ONS Congress by visiting the conference page.

Reference

Roselli T, McNinney T, Miner D. Reducing central line-associated bloodstream infections (CLABSIs) through standardizing ventral venous catheter (CVC) blood draws and chlohexidine gluconate (CHG) treatment usage. Oral presentation at: 47th Annual ONS Congress; April 27-May 1, 2022; Anaheim, California.