Catheter-Associated Blood Stream Infection (CA-BSI) Reduction Project On 2 BMT Inpatient Units

This nursing-centered project was created to reduce the number of CA-BSIs on both the Adult and Pediatric BMT inpatient units. A central venous catheter (CVC) is paramount for the care of the BMT patient. At our facility, we perform autologous and allogeneic transplants. These types of patients require intense, acute nursing care, with some needing critical nursing care. The CVC allows nursing staff to administer medications and blood products, draw blood specimens, and monitor patient hemodymanics. Literature shows there is an increase in CA-BSI risk with multiple entries into the lines connected to the CVC or the CVC itself (Crnich & Maki, 2005). CA-BSIs contribute significantly to morbidity, mortality, and cost (O'Grady, 2002). In an effort to decrease the burden of CA-BSIs, our facility embarked upon a nursing-centered PI project to reduce CA-BSIs. We began our project in early 2008. We have continued into 2009 in order to monitor the outcomes of the interventions. Our implementation strategies in 2008 were three-fold: re-educate all staff, require hands on CVC competencies, and employ the Infection Prevention Department. Education consisted of review of literature, rates, CVC policy review, and correct technique when working with a CVC. During staff's yearly competencies, reviews and updates are given related to the project. They must be checked off on correct CVC technique. Monthly CA-BSI rates are shared with staff and quarterly rates shared with the BMT Quality Committee. We noted a 50% decrease in our CA-BSI rates on both units with the initial rollout of this project and during 2008. We have seen a small rise in our rates in the first half of 2009. We evaluate our interventions on a monthly basis. We consider patient populations, staffing levels, the infecting organism, and other relevant factors. We have made changes to the interventions first defined for this project. We will continue to evaluate our rates based on those changes. As with any project, sustaining change is key. We have experienced an overall reduction in our CA-BSI rates. Our goal is to reduce our rates to below our benchmark and sustain this rate for one year. Inviting nursing staff to the initial project discussion has proven to be an integral piece to the design of this project. Staff has helped us identify and address barriers to change and helped us create strategies to support practice change.