Discussion
Although several interventions were utilized, a few obstacles were also identified in the course of this huge undertaking. For example, some staff were not open to real-time conversations regarding bathing, CHG usage, and monitoring line care. But this also brought to light the lack of communication between the CNAs and nurses regarding bathing. Once this barrier was addressed, evidence of improved communications was seen in chart audits that demonstrated increases in completed baths and CHG usage. To further support this protocol, bathing, linen change, and CHG checklist were added to the dry-erase boards in each patient room to help communicate care practices and include the patient in the process. A CHG wash handout was developed to assist staff in educating patients and families on the importance of the wash in preventing line infection.
The auditing process itself also proved to be a barrier. The charge nurses audited the central venous catheters. Audits included a visual inspection of the dressing and tubing as well as confirmation of daily bathing and linen changes. Some challenges to completing the audits were staff slack, night charges not wanting to wake the patient to view the line, and newer charge nurses forgetting to complete the form. Leaving staff report as the means of charge nurse auditing, sometimes with incorrect reports. These barriers were discussed in a charge nurse meeting, and the group agreed on the importance of completing actual line inspections and renewed their dedication to the process. Through coaching and staff support, the auditing process completion rate improved significantly.
Through the staff’s and leadership’s continued perseverance toward overall patient safety and CLABSI reduction, the unit went 367 days without a documented CLABSI. The CLABSI prevention team continues to identify new interventions to maintain the successful prevention of central line infections on the unit.
One new intervention is a computerized power plan to assure that evidenced-based interventions continue on all central lines on the unit. These care bundles are recommended and supported by the literature and the CDC to reduce CLABSI rates.1
Staffing constraints and turnover continue to be a challenge for the unit. Continuing up-front and real-time communication about CLABSI monitoring is part of addressing these challenges. Communication with the entire care team helps ensure continued successful outcomes in the prevention of CLABSIs on this inpatient cancer care unit.
Amy Walton is a staff nurse on the Inpatient Cancer Care Unit at Billings Clinic, Billings, Montana. Leah Scaramuzzo is RN oncology clinical coordinator, Kalispell Regional Healthcare, Kalispell, Montana.
References
1. Conley SB. Central line-associated bloodstream infection prevention: standardizing practice focused on evidence-based guidelines. Clin J Oncol Nurs. 2016;20(1):23-26.
2. Haddadin Y, Regunath H. Central line associated blood stream infections (CLABSI). In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; January 2018. https://www.ncbi.nlm.nih.gov/books/NBK430891/. Accessed April 30, 2018.
3. Woodward B, Umberger R. Review of best practices for CLABSI prevention and the impact of recent legislation on CLABSI reporting [published online November 1, 2016]. SAGE Open. doi: 10.1177/2158244016677747
4. Frost SA, Alogso MC, Metcalfe L, et al. Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. Crit Care. 2016;20(1):379.