Tissue adhesive and CLABSI reduction
Abstract:
Purpose: Vascular access devices (VADs) contribute to nearly 90% of central catheter–associated bloodstream infections (CLABSIs) and can add thousands of dollars to the cost of an inpatient stay. Patients in an intensive care unit (ICU) are at increased risk for CLABSIs because of high VAD use rates. Patients affected by CLABSIs can experience increased morbidity, mortality risk, and hospital length of stay, which directly affect patient safety and quality of care. Nurses and providers in ICUs continuously handle and manage VADs, thus maintenance and infection prevention are crucial.
Summary: An ICU at an academic medical center had a high CLABSI incidence. Two key areas of improvement were identified: (1) overall reduction in CLABSI incidence and (2) minimization of dressing changes because of site complications. Optimization of VAD management practices was indicated. An interprofessional team was formed with strategic focus on the implementation of an improvement project aimed at decreasing CLABSI incidence. New evolutions in tissue adhesive (TA) technology have yielded benefits when integrated in VAD management, maintenance, and infection prevention practices. Benefits include (1) securement, (2) sealant, and (3) bacteria immobilization. The following population, intervention, control, and outcomes question was developed and tested: In critically ill patients with VAD(s), does the application of a TA to VAD insertion sites result in a reduced incidence of CLABSI when compared with routine CLABSI prevention bundle practices alone? A plan-do-study-act performance improvement framework was used. Before implementation, staff received 30 days of focused education. The improvement project timeline extended over a period of 6 months.
Evaluation/Outcome: Tissue adhesive data were collected at 3 different phases of the project: before implementation, during the pilot period, and after implementation. Data variables were based on nursing documentation in the electronic medical record. Three key areas were analyzed to assess improvement and outcomes: (1) application of a TA at insertion, (2) CLABSI count and rate, and (3) frequency of dressing changes. Through the successful implementation of a TA in the cardiac ICU, an 89% CLABSI reduction was achieved. Furthermore, dressing-change frequency was reduced by more than 50% and no patients were reported as having skin-related reactions.
Reference:
Rodriguez, H and Nuila, C. EB4: CLABSI Reduction Through Use of a Tissue Adhesive in a Cardiac Intensive Care Unit. 2022 National Teaching Institute Evidence-Based Solutions Abstracts. Crit Care Nurse 1 April 2022; 42 (2): e10–e36. doi: https://doi.org/10.4037/ccn2022820.