Vascular Access Team Central Line Dressing Changes to Reduce Infection Risk: A Focused Two-Person Approach in High-Risk Patients

Amelia Draper; Susan Nelson; Beth Taylor; Cassandra Arroyo; Heather Gasama; Robert Russell

doi:10.1097/NAN.0000000000000545

Vascular Access Team Central Line Dressing Changes to Reduce Infection Risk: A Focused Two-Person Approach in High-Risk Patients

J Infus Nurs. 2024 May-Jun;47(3):175-181. doi: 10.1097/NAN.0000000000000545. Epub 2024 May 10.

Authors

Amelia Draper^{1

2}, Susan Nelson^{1

2}, Beth Taylor^{1

2}, Cassandra Arroyo^{1

2}, Heather Gasama^{1

2}, Robert Russell^{1

2}

Affiliations

¹ Author Affiliations: Barnes-Jewish Hospital, St. Louis, Missouri.
² Amelia Draper, MSN, RN, AGCNS-BC, CRNI, has more than 26 years of nursing experience and has held roles in bedside nursing, research, leadership, and advanced practice nursing. Most of her nursing background is in vascular access device placement, maintenance, and removal. At the time of this project, Ms Draper was a clinical nurse specialist in the vascular access services department at Barnes-Jewish Hospital, where she completed the data collection for this article. Susan K. Nelson, MSN, RN, CRNI, is the clinical nurse manager of vascular access service, wound/ostomy inpatient service, and diabetes education inpatient service at Barnes-Jewish Hospital in St. Louis. Ms. Nelson has developed and implemented educational classes at Barnes-Jewish Hospital pertaining to vascular access, including basic intravenous therapy, implanted ports, and central venous catheter discontinuation. She is a member of the Infusion Nurses Society and presented "Implementing an Education Program to Empower Nurses Through Vascular Access Skills and Education" at the 2017 INS Annual Meeting. Beth Taylor, DCN, RD-AP, was promoted to a research scientist position at Barnes-Jewish Hospital in St. Louis after receiving her doctorate in 2014. She is active in the Society of Critical Care Medicine (SCCM), sitting on the council from 2013 to 2016 and serving on several committees, most recently as a cochair for the 2021 SCCM 50th anniversary virtual congress. She has lectured in local, national, and international venues and has published several chapters and peer-reviewed articles. Cassandra Arroyo, MS, PhD, is a Harvard-trained biostatistician and social epidemiologist. With over 20 years of experience, she has specific content and methodological expertise in analysis of large national datasets, analysis of hospital databases, epidemiology of obesity, measurement and analysis of physical activity data, social and behavioral determinants of chronic disease, applied community-based participatory methods for health equity, and impact of the built environment on healthful living. In her current role of lead statistical analyst, she specifically focuses on study design and statistical analysis and methods for patient care services research, evidence-based practice, and quality improvement at Barnes-Jewish Hospital in St. Louis. Heather Gasama, MPH, has worked in public health for 10 years, 5 of which have been focused on hospital infection prevention and epidemiology. After receiving her master's in public health, she spent time working with a local public health agency, determined to decrease environmental hazards to human health (including vector-borne illness and chemical pollution and contamination). She has coauthored several abstracts with her infection prevention colleagues giving insight into isolation precautions, central line risk factors contributing to infection, foley justification, and high-level disinfection. Robert Russell, MBA, MPH, has held 2 positions with Barnes-Jewish Hospital in St. Louis, both with a focus on health care analytics. Currently he serves as a healthcare informatics specialist and has been in this role for 3 years, where he is considered a subject matter expert with broad knowledge of all areas of biomedical informatics and can apply his expertise to complex projects and strategic initiatives. Mr Russell's main area of concentration lies within patient safety and quality, with a particular emphasis on infection prevention, specifically targeting the reduction of hospital acquired illnesses such as central line bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile (C diff), and surgical site infections.

PMID: 38744242
DOI: 10.1097/NAN.0000000000000545

Abstract

Due to low compliance by bedside nursing with a central line-associated bloodstream infection (CLABSI) prevention bundle and increased CLABSI rates, a mandatory re-education initiative at a 1200-bed university-affiliated hospital was undertaken. Despite this, 2 units, housing high-risk immunocompromised patients, continued to experience increased CLABSI rates. A quality improvement before-after project design in these units replaced bedside nursing staff with 2 nurses from the vascular access team (VAT) to perform central vascular access device (CVAD) dressing changes routinely every 7 days or earlier if needed. The VAT consistently followed the bundled components, including use of chlorhexidine gluconate (CHG)-impregnated dressings on all patients unless an allergy was identified. In this case, a non-CHG transparent semipermeable membrane dressing was used. There were 884 patients with 14 211 CVAD days in the preimplementation period and 1136 patients with 14 225 CVAD days during the postimplementation period. The VAT saw 602 (53.0%) of the 1136 patients, performing at least 1 dressing change in 98% of the patients (n = 589). The combined CLABSI rate for the 2 units decreased from 2.53 per 1000 CVAD days preintervention to 1.62 per 1000 CVAD days postintervention. The estimated incidence rate ratio (IRR) for the intervention was 0.639, a 36.1% reduction in monthly CLABSI rates during the postimplementation period.

MeSH terms

Bandages*
Catheter-Related Infections* / prevention & control
Catheterization, Central Venous* / adverse effects
Chlorhexidine* / administration & dosage
Chlorhexidine* / analogs & derivatives
Chlorhexidine* / therapeutic use
Hospitals, University
Humans
Infection Control / methods
Quality Improvement
Vascular Access Devices