Improving Maintenance of Central Line Dressing to Reduce Risk of Central Line-Associated Bloodstream Infections in an Acute-Care Setting.

Abstract

Background: Central line-associated bloodstream infections (CLABSI) increase morbidity, mortality, and healthcare costs. Central venous access device (CVAD) dressing integrity is critical to prevent CLABSI. From the First Quarter to the Third Quarter of 2023, CLABSI rates related to disruption in CVAD dressing integrity increased significantly at our facility. Despite the delivery of education, competency validation, and checklist implementation, CLABSI rates remained high, making this our top strategic priority.The purpose of this quality improvement initiative was to determine if gum mastic adhesive and hemostatic powder would improve dressing integrity and decrease CLABSI rates related to disruption of central line dressings.

Methods: With pre- and post-CVAD dressing data, utilizing rapid Plan-Do-Study-Act methodology to drive improvement, this quality improvement initiative was conducted in a 603-bed, tertiary level I trauma center. A multidisciplinary team was formed consisting of infection prevention, quality, nursing, and vascular access personnel, with the goal of improving central line dressing integrity and increasing dressing life. In-depth training included standardized CLABSI prevention bundles and central line dressing change guidelines to include the application of gum mastic adhesive and topical hemostatic product, and was tested on pilot units before implementation.

Results: Bleeding at the central line insertion site reduced by 23.6% with the use of a hemostatic powder. Central line dressing integrity was improved by 33.5% with the use of a liquid gum mastic adhesive and dressing life improved by 140.7%. Additionally, there was only 1 CLASBI and no medical adhesive-related skin injuries reported since the implementation of the bundle (October 2023).

Conclusion: Topical hemostatic powder and liquid gum mastic adhesive paired with the adhesive remover for safe removal were shown to be effective in improving integrity in central line dressings for the prevention of CLABSIs. In October 2023, the dressing change integrity bundle was scaled to all units within the facility.