A Quality Improvement Initiative to Increase Central Line Maintenance Bundle Compliance through Nursing-led Rounds

Abstract

Introduction: Improvements in maintenance bundle compliance around central line-associated bloodstream infections (CLABSIs) lack standardization. The objective was to implement a formalized nursing-led rounding process, Rounds for Influence, with a goal of 12 rounds/wk on each inpatient unit and Ambulatory Infusion Center, achieving > 90% maintenance bundle compliance. Methods: Nurses served as peer “influencers” to perform rounds. The CLABSI prevention team created three comprehensive rounding tools (line access, dressing change/port needle insertion, and cap change) on a digital platform. The team designed these tools to assess clinical competence for maintenance bundle components and implemented nine plan-do-study-act cycles throughout the study period. Results: Influencers completed 191 rounds after the first month of implementation, resulting in a 264.2% increase from the baseline of 52.5 rounds per month. Over the 2.5 years postimplementation, rounds resulted in 7836 total observations. Maintenance bundle compliance decreased from 86.9% (centerline value from November 2017 to September 2018) to 40.8% after the first month of implementation. Compliance increased iteratively (two separate centerline shifts) to a current centerline value of 87.1%. The CLABSI 12-month cumulative standardized infection ratio (SIR) was 0.9 in November 2017 and dropped to 0.53 in June 2021. Conclusion: Implementing a formalized nursing-led rounding process led to increased maintenance bundle compliance, decreased CLABSI SIR, and is an integral part of nursing practice. Given this success, there is interest from other hospital-acquired condition improvement teams in applying this rounding practice to their improvement work.

Formative Evaluation of CLABSI Adoption and Sustainment Interventions in a Pediatric Intensive Care Unit

“…Previous studies revealed a statistically significant reduction in CLABSIs with adherence to CLABSI maintenance bundles. 22,23 In contrast, this study found that CLABSI rates remained low even during times when compliance auditing was not possible because of staffing constraints. We cautiously interpret these findings to suggest that the CLABSI champion, viewed as a clinical expert, promoted awareness of the CLABSI bundle that in turn maintains low CLABSI rates.…”

Vascular Access Team Central Line Dressing Changes to Reduce Infection Risk

“…1 A CLABSI may present in a patient in an intensive care unit (ICU) or non-ICU setting and is associated with an increased hospital length of stay, readmission, and antibiotic use. [3][4][5][6][7] A single CLABSI can cost the hospital between $40,412 and $100,980, with an average cost of $70,696. 8 In addition, CLABSI rates are used as a measure of performance in various hospital rating systems for defining overall patient quality of care.…”

“…The risk of infection increases the longer the CVAD is in place 1. According to the 2024 Infusion Nurses Society (INS) Infusion Therapy Standards of Practice (the Standards ), a central line-associated bloodstream infection (CLABSI) is defined as “a primary bloodstream infection in a patient who had a CVAD the day of or day before infection and had more than 2 days of central access.”2 In the National Healthcare Safety Network definition, it is stated a CLABSI is “a laboratory confirmed primary bloodstream infection that is not secondary to an infection at another body site, urinary tract infection, pneumonia, and surgical site infection.”1 A CLABSI may present in a patient in an intensive care unit (ICU) or non-ICU setting and is associated with an increased hospital length of stay, readmission, and antibiotic use 3-7. A single CLABSI can cost the hospital between $40,412 and $100,980, with an average cost of $70,696 8.…”

Preventing Central Line Bloodstream Infections: An Interdisciplinary Virtual Model for Central Line Rounding and Consultation

“…5 An evidence-based bundle approach, in which a variety of clinical best practices are combined for insertion and maintenance of CVCs, has been documented in many studies and quality improvement projects. [6][7][8] Adequate training, education, staffing, and leadership involvement are equally important standards in CLABSI prevention, 9 as is the use of chlorhexidine (CHG) bathing. 10 Removal of a central line when it is no longer clinically necessary is an important aspect of infection prevention.…”