Keywords
CLABSI; dialysis; patient safety; infection prevention; interdisciplinary team; standardization
Disciplines
Critical Care Nursing | Nursing Administration | Occupational and Environmental Health Nursing | Palliative Nursing | Public Health and Community Nursing
Abstract
Background
This quality improvement project was initiated to reduce hospital-acquired catheter-associated bloodstream infections (CLABSI) in hospitalized patients receiving dialysis. A team dedicated to reducing hospital-acquired infections led the implementation of evidence-based interventions across all the included hospitals. This innovative approach demonstrated substantial enhancements in outcomes for patients on hemodialysis.
Methods
To enhance patient safety in patients receiving hemodialysis, new strategies were implemented, including (1) transitioning from a vendor model to an internal model, enabling dialysis program standardization, (2) empowering intensive care nurses with increased autonomy and ownership, (3) transitioning to a standardized dialysis machine, and (4) introducing chlorhexidine gluconate (CHG) impregnated caps and CHG pads. To reduce CLABSI in hemodialysis lines, a multidisciplinary team was formed comprising physicians, nurses, a dialysis technician, pharmacists, the dialysis director, the chief medical officer, the chief nursing officer, the assistant chief nursing officer, the infection preventionist, and the quality director. The team implemented a standardized approach to caring for hemodialysis lines, provided just-in-time education to staff, and standardized policies simultaneously at 8 hospitals. Initially, 1 facility served as the pilot facility for facility-owned dialysis services, totaling 9 facilities providing in-house standardized dialysis services. Data was reported back for monthly evaluation.
Results
Overall, there was an 88% reduction in CLABSI occurrences in hemodialysis lines from pre-intervention (n = 8) to post-intervention (n = 1), X2 (1, N = 4112) = 4.181, P = .0408. Collaboration on these initiatives improved communication and enhanced quality care and patient safety across the entire spectrum of care.
Conclusions
Implementing innovative tracking of standardized approaches to patient care and infection prevention and evidence-based interventions resulted in decreased CLABSI rates, improving outcomes in vulnerable patients. An unintended benefit of this project was the increase in multidisciplinary collaboration.
Recommended Citation
Roderman, Nicki; Moore, Kasadi; Wilcox, Shandlie; Jellerson, Jennifer; and Bridges, Zoey
(2024)
"Central Line-Associated Bloodstream Infection Reduction in Hemodialysis Patients Across 9 Hospitals and 3 States,"
HCA Healthcare Journal of Medicine: Vol. 5:
Iss.
5, Article 10.
DOI: 10.36518/2689-0216.1910
Available at:
https://scholarlycommons.hcahealthcare.com/hcahealthcarejournal/vol5/iss5/10
Included in
Critical Care Nursing Commons, Nursing Administration Commons, Occupational and Environmental Health Nursing Commons, Palliative Nursing Commons, Public Health and Community Nursing Commons