Presented at: Institute for Healthcare Improvement National Forum, Orlando, FL December 8-11, 2013
Nursing Survey Reveals Novel Strategy
in Assisting Adherence to Best Practices of
CVC Dressing Management
BACKGROUND
Catheter-related bloodstream infections
(CRBSIs) are a serious complication related
to vascular access, and are associated with
increased hospital length of stay, mortality,
and costs. Effective catheter-related CRBSI
prevention requires multiple interventions and
adherence to evidence-based best practices.
Evidence-based guidelines published by
Society for Healthcare Epidemiology of
America/Infectious Diseases Society of
America (SHEA/IDSA) and the Centers for
Disease Control and Prevention (CDC)
highlight best practices for prevention and
monitoring within acute care hospitals before,
during, and after CVC insertion. According to
*Mastisol® and Detachol® (Eloquest Healthcare, Inc, Fernadale, MI)
Timsit et al, a cornerstone of CRBSI prevention
is dressing management and prevention of
dressing disruption.
Our CRBSI infection rates were higher than
desired, and we were able to ascertain they
were not insertion related; therefore, we started
looking at the care and maintenance of the
lines. It became evident that we had challenges
with dressing attachment and securement.
A quality improvement (QI) initiative was
conducted to assess the effectiveness of new
products* for enhancing dressing securement
and preventing detachment.
EL47 01/14
METHODS
CLINICAL SETTING: A 247-bed community
hospital with two separate intensive care
units participated in this QI initiative.
SURVEYS: Before and after surveys were
conducted to determine whether the revised
products utilized for dressing securement
and detachment impacted adherence to
evidence-based best practices.
R E S U LT S
A comparison of before and after surveys
revealed the nursing staff felt use of the
revised products for dressing securement
and detachment increased adherence to
evidence-based best practices for CRBSI
prevention and catheter management. There
were fewer dressings compromised due to
mechanical forces and fewer dressings were
compromised prior to 7 days. Furthermore,
fewer dressings were compromised due
to excess moisture. Additional results are
reported in the below figures. Of interest,
the additional step required for application
of a product for attaching and detaching
dressings did not result in decreased
productivity, as before and after surveys
revealed time spent applying and changing
dressings did not change significantly.
CVC Dressing Compromised Due to Excessive Moisture
CVC Dessing Change Frequency, Prior to 7 Days Because they are Compromised
49%
60%
50%
51%
40%
50%
31%
29%
% of Respondents
% of Respondents
40%
30%
21%
20%
16%
9%
10%
5%
0%
0%
0%
0%
44%
40%
28%
30%
24%
20%
14%
7%
10%
0%
0%
0%
22%
5%
2%
0%
0%
2%
0%
0%
0%
0% of the Time
<25% of the Time
25% of the Time
50% of the Time
Pre-Implementation
75% of the Time
>75% of the Time 100% of the Time
Post-Implementation
0% of the Time
<25% of the Time
25% of the Time
50% of the Time
Pre-Implementation
75% of the Time
>75% of the Time 100% of the Time
Post-Implementation
R E S U LT S
CVC Dressing Comprommised Due to Mechanical Forces
50%
Time to Remove and Replace CVC Dressing
80%
44%
40%
30%
58%
60%
23%
18%
20%
14%
9%
9%
10%
65%
70%
33%
% of Respondents
% of Respondents
40%
50%
40%
30%
5%
2%
2%
0%
0%
0%
0%
25% of the Time
25% of the Time
50% of the Time
Pre-ImplementationP
75% of the Time
22%
10%
0%
0%
0% of the Time<
21%
18%
14%
20%
3-4
Minutes
>75% of the Time 100% of the Time
5-9
Minutes
3-4
Minutes
Pre-ImplementationP
ost-Implementation
Skin Injuries Observed upon Dressing Removal
2%
3-4
Minutes
ost-Implementation
Frequency of Skin Irritation/Injury Upon Dressing Removal
56%
60%
50
42
34
32
31
30
% of Respondents
# of Respondents
47%
50%
40
26
17
20
7
10
40%
33%
30%
18%
18%
20%
14%
8
7
5
7%
10%
2
1
0%
5%
2%
0%
0%
0%
0%
0%
0
Redness
BleedingM
inor Skin Tear
Pre-Implementation
Major Skin Tear
Hair Removal
None
Post-Implementation
0% of the Time
<25% of the Time
25% of the Time
50% of the Time
Pre-Implementation
75% of the Time
>75% of the Time 100% of the Time
Post-Implementation
C L I N I C A L I M P L I C AT I O N S
• The before and after survey revealed
nurses believed use of the products
for securing and removing CVC dressings
helped them adhere to best practices for
CVC management.
• In each survey criteria, nurses found that
products used post-implementation
helped maximize short-term CVC
dressings.
• Less damage to the patients skin was
experienced post-implementation.
• Fewer dressing detachments occurred
due to moisture.
• Adding post-implementation products
to central line dressing kits helped
increase compliance.
ACKNOWLEDGMENTS
The authors would like to thank Stephanie Etter RN, Infection Prevention Manager Dana Hickey
RN, Infection Preventionist for their efforts in preventing infections with central lines and data
collection and support expertise; and the ICU Practice Council for their evidence-based efforts
associated with central line infection prevention.
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5. Shannon RP, Patel B, Cummins D, Shannon AH,
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Ganguli G, Lu Y. Economics of central line-
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Healthcare Safety Network (NHSN) report:
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Data summary for 2006 through 2008, issued
is a major risk factor for catheter-related
December 2009. Am J Infect Control. 2009;37:
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783-805.
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The development of this poster was supported by Eloquest Healthcare®, Inc., and the authors maintained total editorial control of content.