458 Transforming a Team: A Key to Reducing Central Line-associated Bloodstream Infections

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
James S. Davis, BSN, RN, CCRN, CIC , Abington Memorial Hospital, Abington, PA
Jean Harpel, BS, RN, CCRN , Abington Memorial Hospital, Abington, PA
Collette Hendler, MS, RN, CIC , Abington Memorial Hospital, Abington, PA
Terry Reilly, MSN, RN, NEA-BC , Abington Memorial Hospital, Abington, PA
Background: Abington Memorial Hospital transformed a traditional IV Team, whose role was primarily IV catheter insertion, into a Vascular Resource Team that is responsible for mentoring bedside nurses in IV catheter insertion and care, and monitoring vascular care. This collaborative approach between the bedside nurses and the Vascular Resource Team led to a hospital-wide reduction in central line-associated bloodstream infections (CLABSI).

Objective: Describe the clinical, financial, and professional gains of transforming a traditional IV Team into a Vascular Resource Team that mentors staff nurses in performing high-quality, evidence-based vascular access care.

Methods: The IV team nurse position description was revised to reflect the changing role; from IV inserter to vascular access educator. The Vascular Resource Team staffing was reallocated leading to a workforce reduction of two fulltime equivalents (FTE). Bedside nurses were educated by the vascular educators in peripheral IV insertion and central line maintenance techniques and supported with regular bedside feedback of outcome / audit data.

Results: Before restructuring the IV team, CLABSI rates in the medical-surgical units exceeded 6 per 1,000 line days. Since the inception of the Vascular Resource Team model, CLABSI rates have remained consistently under 2 per 1,000 line days. The overall hospital rate (critical care and medical surgical units combined) was greater than 4 per 1,000 line days; reduced to less than 2 per 1,000 line days. In addition, compliance with central line dressing changes rose from 68% to more than 90%. Financially, the reduction in CLABSI saved an estimated $25,000 to $60,000 per infection and the reduction in two FTEs saved an estimated $160,000 annually. Advancing the IV nurse’s practice as teaching experts increased their job satisfaction. Moreover bedside nurses verbalized increased satisfaction because they became more competent with their IV insertion and central line care.

Conclusions: Transforming the IV team into a Vascular Resource Team that specializes in vascular education has reduced infection rates and cut cost. The redesign has increased job satisfaction for the Vascular Resource Team and the bedside nurses. This transformation is truly a best practice in vascular access care.