Purpose - What was the goal of the study?: The goal of the study was to standardize the time of central line assessment; definition of what clean, dry, and intact means, and visual indicator to notify others if the dressing was compliant or not with definition.
Background - What was the problem? Why was it important?: Clean, dry, intact central line dressing definitions are not uniformly applied by nursing staff. At the same time, the moment of first observation of the central line can vary from beginning of shift to hours or not at all. Central line dressing evidence recommendation range from 1A to 1C from the CDC 2017 Guidelines for Prevention of Intravascular catheter related infections. Compromised central line dressing integrity was 1 of 4 most common attributes from Apparent Cause Analysis findings for Central line associated Bloodstream infection (CLABSI). The facilities CLABSI team comprised of nursing, physician, infection Preventionist, VAT (Vascular Access Team), data analysts, and process improvement developed an A3 format to investigate root causes of this and develop rapid tests of change to correct it. The team decided to use a visual cue card with standardized definitions for dressing integrity to be used during bedside shift report by nursing staff to denote their assessment of the central line dressing.
Results - What were the findings?: 27 observations over the course of 4 weeks were made on the trial unit. Staff utilized the visual cue card 73% of the time (19/27). Findings show an increase of 67% to 96% of dressings dated, 96% to 100% of dressings dated within 7 days, 91% to 96% of dressings were intact, and 97% to 100% of CHG patches were applied appropriately. Staff who did not utilize the visual card missed 42% (3/7) of compromised dressings, while those who utilized the card missed 11% (2/19) of compromised dressings.
Conclusions - What do the final outcomes mean?: Based on test of change, there is evidence to suggest utility to the process of using a visual cue card with standardized definition of clean, dry, and intact which is performed at a set time of the shift for improving identification of compromised dressing integrity, and ensure all staff follow standards of care with central line dressings. Future work will focus on shortening the time from dressing identified as needing change to having it changed.
.jpg "Aaron Preston, BSN RN CIC photo")