An intervention that used a task simulator to educate 25 nurses on the use, care, and maintenance of central venous catheters (CVCs) reduced the rate of central-line–associated bloodstream infections (CLABSI) in an adult inpatient hematology–oncology unit at the University of Vermont Medical Center. The use of CVCs is associated with a risk of developing CLABSI—and patients with cancer, whose care often requires CVCs, are at an increased risk for this infection due to side effects of chemotherapy (mainly, a lowered immune system and neutropenia). The study was reported in the article, “Reducing Oncology Unit Central Line-Associated Bloodstream Infections: Initial Results of a Simulation-Based Educational Intervention,” published in the Journal of Oncology Practice.1
Dr. Ted A. James
Few CLABSI Interventions Have Focused on Maintenance Care Carried Out by Nurses
The study was designed to address a gap in CVC interventions and educational programs: Many quality improvement initiatives have focused on the moment that doctors insert the line into patients, but fewer studies have focused on the tasks nurses carry out after the line is inserted.
Ms. Jenna Page
Identifying Educational Gaps
In designing the study, a team consisting of a nurse educator, an assistant nurse manager, nine staff nurses, and an infection-prevention consultant performed a retrospective review of hospital records to determine the frequency of CLABSI for the 6 months before the start of the intervention. The team also reviewed the medical centers’ policies on CVC care and met with an infection-control specialist, who helped devise a definition of CLABSI.
In the next step, the team created a 31-question multiple choice pretest designed to identify gaps in nurses’ knowledge regarding standards of care for CVCs. Based on the gaps identified in the pretest, the team created a two-part educational series, which was carried out over 6 months. During this 6-month period, nurses individually met with the nurse educator and used a training simulator to practice several care tasks, including identifying and caring for central lines, using a heparin flush, drawing labs, and changing dressings.
Reduced CLABSI Rates
The intervention was associated with an increase in nurses’ knowledge about CVC care: On the pretest, which was administered before the educational series, nurses scored an average of 74.3%, while on the post-test, the score jumped to 91.2%—a 16.9% improvement. The rate of CLABSIs on the oncology unit before and after the intervention was another indication that nurses were standardizing their skills in caring for CVCs and adhering to best practices: During the 6 months before the intervention, the CLABSI rate was 5.86 per 1,000 patient line–days; during the 6 months of the intervention, the rate decreased to 3.45, and during the 6 months after the intervention, the rate dipped to 3.43. After introducing a visual audit tool in the seventh month after the intervention, the rate of CLABSIs went down even further, to 1.42—a rate significantly lower than before the intervention.
Dr. James stated that a unique aspect of this study is its multimodality approach. “Jenna and the implementation team focused on administrative policies, they focused on standardizing protocols in terms of nursing practice, and they incorporated a structured education framework to identify and correct any deficiencies in practice,” Dr. James said. “In addition, the study has a longitudinal monitoring component, where we’re tracking data and carrying out audits to see if people are maintaining their competencies.”