Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-11-2024

Graduate Advisor

Sarah Jackson, DNP, APRN, FNP-C

Co-Advisor

Candace-Rae Davis, DNP, APRN, ACCNS-P, CNP-PC/AC

Committee

Rachel Allen, DNP, PNP-AC

Abstract

Problem: Central line-associated bloodstream infections (CLABSIs) are a significant, preventable healthcare-related complication of hospital admission and medical management of critically ill and medically complex patients. CLABSIs result in significant adverse outcomes such as increased morbidity and mortality, prolonged length of stay (LOS) in the intensive care unit (ICU) and in the hospital, increased cost of treatment, and increased rates of readmission. Direct and indirect contact within the patient’s hospital environment are potential means of transmission for microorganisms, increasing the inherent risk of acquiring a CLABSI.

Method: For this quality improvement (QI) project, a pre-post design was utilized to evaluate the effect of a standardized high touch surface cleaning protocol on CLABSIs. This was completed with the utilization of retrospective and prospective chart review three months prior to and following the implementation of this protocol. Nurses were provided with education via a virtual staff meeting four weeks prior to implementation as well as the utilization of infographic bathroom flyers. The QI project evaluated number of CLABSIs, nursing compliance, and LOS in the ICU.

Results: Seventy-six patients with 87 central lines met criteria and were included in this QI project. There was one CLABSI in three months prior to implementation and one CLABSI during the study period. The average PICU LOS was 18.29 days. RN compliance with cleaning high touch surfaces together was 11.54%.

Implications for Practice: After evaluating the implementation of the new high touch surface cleaning protocol in the pediatric ICU (PICU), the number of CLABSIs were the same. Clinical significance was exemplified as the PICU remained CLABSI-free for over 100 days after the study period ended. More research is necessary, including future studies containing more pediatric patients, greater sample sizes, multiple ICUs or institutions, and longer study periods.

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