Oncology Nurses Drastically Reduce Central Line Infection Incidences Through Peer-to-Peer Observation Strategy

Oncology nurses can help reduce the number of central line-associated bloodstream infections (CLABSIs) in patients undergoing hematopoietic stem cell transplant (HSCT) by standardizing central venous catheter (CVC) blood draws and chlorhexidine gluconate (CHG) treatment usage, according to a presentation at the 2022 Transplantation & Cellular Therapy Meetings.

Following a peer-to-peer observation and validation process was implemented in June 2021, there was a 68% decrease in CLABSI incidences at NYU Presbyterian 10 West. The number of incidences improved from 2.82 events per 1000 central line days (pre-intervention January to May) to 0.90 events per 1000 central line days (June to August).

“Oncology nurses play a primary role in implementing strategies to help reducing preventable CLABSI,” Thanyanee McNinney, BSN, RN, OCN, of the New-York Presbyterian Department of Nursing, said in a poster presentation of the findings.

CLABSIs represent a significant mortality risk to patients and are also linked with financial toxicities; one case of CLABSI can cost around $40,000.

Furthermore,factors including long term central line placement and usage, high-dose chemotherapy, prolonged immunosuppression, and the possibility of posttransplant complications such as graft-vs-host-disease (GVHD) mean that patients undergoing HSCT are especially vulnerable to CLASBI. However, research has demonstrated that proper insertion techniques and central line management can help prevent CLABSI.

In 2020, there were 0.51 CLABSIs per 1000 central line days at the investigator’s institution; by the second quarter of 2021, there were 2.82 CLABSIs per 1000 central line days.

Therefore, investigators sought to increase competency and reduce the incidence at their institution. Their objective was to reduce incidence by 20% within 3 months on a 16-bed HSCT inpatient unit in an academic medical center.

Investigators collaborated with the Hospital Acquired Infection (HAI) champions and nursing leadership teams to develop an action plan. This plan consisted of a thorough root to cause analysis of incidences, interdisciplinary huddles, standardized validation tools to allow peer-to-peer observation and validation during blood culture and blood specimen collection via central lines and CHG use.

The CVL peer feedback tool assessed whether observed staff performed proper hand hygiene when indicated, needle endcaps were clean, CVC ports/lines not being used had an alcohol impregnated endcap in place, all intravenous (IV) tubing not being used had a red cap, that no IV tubing were expired and had adequate labels indicating last line change, and that the CVC dressings were clean, intact, and not reinforced.

Following peer-to-peer observation and validation, it was revealed that 35% of nurses did not adhere to NYP policy when collecting blood cultures or drawing blood via a central line. Furthermore, 66% of nurses did not know how to perform CHG treatments correctly.

In addition, the study revealed multiple opportunities for growth. Among some of the registered nurses, peers observed the donning of gloves without performing hand hygiene, opening equipment without proper aseptic technique; insufficient scrubbing of the hub, failure to replace new Q-site prior to drawing blood cultures, drawing blood cultures directly through the lumen without a new Q-site placement, and a failure to flush with required amount of normal saline post-blood draw and performing push-pause technique when flushing.

Ultimately, nurses can be pivotal in reducing CLABSIs by educating staff members on proper CHG wipe usage and standardizing central line blood draws. These efforts are consistent with the “zero harm” initiative adopted at various institutions and represents a commitment to providing a safe and caring environment for patients and staff by eliminating all preventable patient injuries and infections.

Reference

McNinney T, Roselli T, Miner D. Reducing central line-associated bloodstream infections (CLABSI) through standardizing central venous catheter (CVC) blood draws and chlorhexidine gluconate (CHG) treatment usage. Presented at: 2022 Tandem Meetings Transplantation & Cellular Therapy Meetings of ACTCT and CIBMTR; April 23-26, 2022; Salt Lake City, UT. Abstract 612. https://bit.ly/3Pf32OD