Date of Award

Summer 2022

Project Type

Thesis

College or School

CHHS

Department

Nursing

Program or Major

Direct Entry Master's in Nursing

Degree Name

Master of Science

First Advisor

Elizabeth Evans

Abstract

BACKGROUND: Central line-associated bloodstream infections (CLABSI) are the most common type of preventable healthcare-associated bloodstream infection, and may increase length of stay (LOS), facility treatment costs, and patient mortality rates. Intensive Care Unit (ICU) patients are especially vulnerable to CLABSI due to their critical health conditions and other comorbid factors. A literature review provided evidence supporting the use of alcohol-impregnated disinfectant caps, such as SwabCap®, on central line (CL) ports to significantly reduce patients’ risk for CLABSI. This quality improvement project took place within an adult ICU of a Level II trauma facility in New England, where the Infection Prevention (IP) team’s weekly ICU audit data showed use of these caps on patient’s CLs to be inconsistent and trending negatively from February to May 2021. In recent 2022 audits, cap use on CLs was still <100%, with 78% in March and 80% in April. This project focused on improving CL capping protocol adherence in the ICU from <100% to 100% to reduce patients’ risk for CLABSI and maintain this microsystem’s CLABSI rate of zero throughout 2022.

METHODS: The Plan, Do, Study, Act (PDSA) framework was used to guide this QI process and improve CL disinfectant cap protocol adherence in the ICU. A tick-and-tally survey was conducted among 19 staff nurses to determine barriers, revealing that 84% regarded lack of convenient cap access as the main reason for poor protocol adherence. The intervention was developed based on this information. Outcome data on percentage of CLs appropriately capped and intervention participation were then gathered throughout June 2022 via weekly IP audits.

INTERVENTION: To improve cap accessibility, staff were encouraged to hang one cap bag on each CL patient’s IV pole and replace it as-needed. This intervention was introduced during two change-of-shift huddles and via a staff-wide email and six informative pamphlets hung throughout the unit. Staff and leadership meetings were also scheduled throughout the project to reinforce participation.

RESULTS: The project goal of 100% appropriate cap use was not met, with cap use averaging 75% in June, a decrease from the 78% recorded in March and 80% in April. Intervention consistency on the unit was also low after implementation, averaging 69% in June. However, the microsystem did not experience any CLABSI events and staff/leadership verbalized that they felt the intervention was helpful in overcoming barriers to cap accessibility.

CONCLUSIONS: Limitations of this project included the lack of intervention consistency, competing stakeholder priorities, and infrequent IP audits (occurring only once a week) which reduced the amount of data for analysis. Further study is recommended to evaluate staff’s qualitative response suggesting this project was helpful in overcoming identified barriers, since the quantitative data did not show an associated improvement. Staff should be resurveyed to identify strengths/weaknesses of the project, and other barriers that may have contributed to the decrease in protocol adherence should be explored to develop and modify the intervention for the next PDSA cycle.

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