Date of Award

Summer 2023

Project Type

Thesis

College or School

CHHS

Department

Nursing

Program or Major

Direct Entry Masters of Nursing

Degree Name

Master of Science

First Advisor

Elizabeth Evans

Abstract

BACKGROUND: Central line-associated bloodstream infections (CLABSIs) are a type of hospital-acquired infection (HAI). They arise as a complication from patients having a central venous catheter (CVC) placed. CVCs can provide numerous benefits for patients who require long-term venous access or hemodynamic monitoring. Acquiring a CLABSI can place patients at higher risk for complications, increased length of stay, and mortality. Reducing the risk of infection is imperative for all patients, but especially those who are more vulnerable to opportunistic infections, such as those in critical care units.

LOCAL PROBLEM: This quality improvement project took place at a 234-bed, level II trauma center hospital in the Seacoast region of New Hampshire. The aim of this quality improvement project was to improve CVC dressing integrity through re-education of the application protocol and subsequently decrease the risk for CLABSIs.

METHODS: The Plan, Do, Study, Act (PDSA) framework was utilized to design and carry out this quality improvement project. Based on auditing conducted by the infection prevention team, it was concluded that there was a lack of understanding of the dressing application protocol which may have been contributing to the decreased integrity of the CVC dressings.

INTERVENTION: The intervention was centered around re-education for the staff nurses on the unit. Both a pamphlet and an instructional video were developed highlighting key points about the benefits of the CHG dressings in preventing CLABSIs as well as demonstrating the proper steps for dressing application to optimize integrity. The educational materials were disseminated to all nurses on the unit via email.

RESULTS: Data was collected via weekly auditing sessions with the infection prevention team utilizing an updated CVC maintenance checklist that was altered to address the needs of this project. The data collection revealed that only a 54% adherence rate for the application protocol was achieved. There were no reported CLABSIs during this period. There was no statistically significant difference between dressings from pre-intervention to post-intervention for either category (“clean/dry”; p = 0.278, “intact”; p = 0.442).

CONCLUSIONS: Although the intervention did not meet the specific aim or yield statistically significant results, there are several limitations that may have contributed. Limitations included a lack of acknowledgment and engagement with the educational materials by the nurse, assessment of dressings not placed by nurses on the unit, infrequent auditing sessions, as well as differing sample sizes between pre-intervention and post-intervention. Whilst the specific aim was not met, the infection prevention team and nurses on the unit expressed their encouragement for the project and the hopes to implement in more capacities throughout the hospital.

Keywords: Central line-associated bloodstream infections (CLABSIs), CHG Tegaderm dressings, infection prevention, dressing integrity

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