The Role of Nurses in Reducing Central Line Associated Bloodstream Infections Outside the ICU: A Multihospital Education Intervention

Background:

Effective July 2010, the Joint Commission has recommended that Central Line Associated Bloodstream Infection (CLABSI) surveillance and prevention be performed hospital wide. Our multihospital surveillance previously showed that the burden of CLABSI is higher outside the ICU. Therefore, we implemented an educational intervention program educating nurses on post-insertion care in non-ICU patient units, and evaluated the impact of this intervention on reducing CLABSI rates.

Objective:

1) To educate nurses through a web-based module on best practice guidelines for post-insertion line care; 2) Evaluate the impact of education on nurses’ knowledge and line care practices before and after the education; and 3) Compare CLABSI rates before, during, and after nurses’ education.

Methods:

Thirty-seven non-ICU units at six hospitals in the Rochester, NY area participated in the project since 2008. The approach consisted of: 1) Educational intervention using a computer based training (CBT) module; 2) Survey of nurses on their post-insertion central line care before and 6 months after completion of the education; 3) Audits of nurses’ line care practices; 4) Feedback of data on central line related bloodstream infections to each unit on a quarterly basis. Quarterly CLABSI rates were computed and compared over time in relation to the intervention implementation using Poisson regression.

Results:

During the pre-intervention period the overall CLABSI rate for all the participating units was 2.9/1,000 line days. Post intervention, there was a statistically significant 49% reduction in CLABSI rate to a mean rate of 1.5/1,000 line days (rate ratio (RR) 0.51; 95% CI 0.38-0.70). Although decreases were observed for all units, the intervention effect was statistically most apparent on specialty care units (bone marrow transplant,oncology) where the CLABSI rate dropped from a mean of 5.2 to 2.7/1,000 line days (RR 0.51; 95% CI, 0.31- 0.84). Comparing hospitals, the CLABSI rate significantly dropped at the larger teaching hospital with the highest pre-intervention CLABSI rate (rate 4.9 to 1.9/1,000 line days, RR 0.38; 95% CI, 0.25-0.58). When comparing the effect of intervention on the type of central line we observed a significant drop in PICC related bloodstream infections (2.6 to 1.2/1,000 line days, RR 0.51; 95% CI, 0.32-0.81). Survey of nurses prior to the education identified a lack of knowledge on the importance of thoroughly cleaning the central line needleless access device before accessing. Post education, both survey and auditing of nurses’ procedures suggest that the devices were scrubbed more thoroughly.  

Conclusions:

Educating nurses on proper post-insertion central line care in conjunction with audits and feedback of CLABSI rates led to a significant decrease in CLABSI rates in units outside the ICU, especially on units with higher rates.