A Clinical Nurse Specialist–Led Quality Improvement Initiative to Identify Barriers to Adherence to a Bundle for Central Line Maintenance

Abstract

Purpose This clinical nurse specialist–led quality improvement project identified barriers to adherence to a bundle for central line maintenance and examined the relationship between increased bundle adherence and central line–associated bloodstream infections. Project Description Oncology and critical care nurses were surveyed to identify barriers to adherence to a bundle for central line maintenance. Targeted initiatives based on survey responses were implemented focusing on antimicrobial bathing, increasing confidence in an evidence-based bundle, and its ability to reduce infections. Adherence and central line–associated bloodstream infection rates were monitored at baseline and at 3, 9, and 15 months post intervention. Outcomes Adherence to bundle elements improved post intervention in 4 areas in critical care units: correctly labeling catheter dressings, maintaining an occlusive dressing, clamping unused catheter lumens, and daily antimicrobial bathing. In oncology units, adherence improved in clamping unused lumens and daily antimicrobial bathing. At 9 months post intervention, infection rates decreased from 6.08 to 1.48 in critical care units and 3.13 to 0.30 in oncology units. Conclusions Identifying unit-specific barriers to adherence to bundles for central line maintenance and implementing targeted initiatives to reduce barriers increase adherence and prevent central line infections.