1 Prevention of Central Line-Associated Blood Stream Infections: A Quality Improvement Plan College of Nursing, University of South Alabama NU-613-808: Organizational & Systems Leadership

Prevention of Central Line-Associated Blood Stream Infections A central line-associated bloodstream infection (CLABSI) is a bloodstream infection that is laboratory-confirmed and occurs within 48 hours of the placement of a central line. It is unrelated to an infection occurring at a different location on a patient. Most importantly, it is a preventable healthcare associated infection; however, it occurs quite frequently. A quality improvement project can significantly impact the decline of CLABSI occurrences within the inpatient setting by implementing evidenced-based practices for central line maintenance. Background and Problem CLABSIs are a leading cause of death worldwide and contribute to excess costs to the healthcare system. Latif et al. (2015) found 1 in 25 hospitalized patients in the United States to be affected by a CLABSI, resulting in approximately 100,000 deaths and costing up to $40 billion annually. The occurrence of a CLABSI prolongs a patient’s hospital stay as it adds an additional illness to treat. Being that a CLABSI is a healthcare associated infection (HCAI), a quality improvement project with an aim to prevent its occurrence at the bedside with appropriate central line maintenance practices will decrease the annual prevalence of CLABSIs. Change Theory In healthcare, there is always opportunity for change resulting in quality improvement. Lewin’s change theoryinvolves a three-step model consisting of unfreezing, changing, and refreezing. Unfreezing is the stage in where awareness is brought to a problem, encouraging adaptation to new practices while letting go of current ones. Such can be accomplished through staff education and engagement, providing an opportunity for additional learnings, and addressing concerns as they arise. The second stage involves demonstration of the benefits of

3 change which can include statistical data. A new practice may be the administration of chlorhexidine gluconate baths three times a week versus the once-a-week protocol currently implemented. As this adds additional duties for the bedside nurse, their commitment and ownership to compliance with new practices is crucial in achieving the common goal. Finally, the last stage of Lewin’s change theory is refreezing new practices, so they become a new norm and resist further change. When the staff is able to witness the benefits of updated central line maintenance practices, they will feel empowered to remain compliant with them as they positively benefit the patients they care for (Burnes, 2004).