An educational intervention to increase CLABSI bundle compliance in the ICU

Title: An Educational Intervention to Increase CLABSI Bundle Compliance in the ICU Context: “Forty-eight percent of patients in intensive care units (ICU) require central line placement for administration of fluids and medications†(How-to Guide, 2012). However these lines potentially pose serious complications for patients including central line-associated bloodstream infections (CLABSI). Hospitals have placed great emphasis on preventing CLABSI by use of evidenced based central line bundles. Objective: The purposes of this study were to evaluate nursing documentation compliance rates with central line bundle adherence, and to determine if the CLABSI rates significantly decreased post central line bundle educational intervention in the ICU. Design: This study consisted of a retrospective and prospective analysis of electronic record documentation of central line bundle compliance and CLABSI rates. Setting: The study took place in a hospital ICU in Northwest Arkansas. Patients: This study utilized a convenience sample of selected patients admitted to the ICU who required a central line placement during the study period of October and November of 2012 and March and April of 2013. A combined pre and post 100 electronic charts were audited. Interventions: Chart reviews of randomized ICU patients with central lines inserted were examined to determine CLABSI rates two months pre and post educational intervention. Medical record numbers were selected by the hospital sponsor and based on patients in the ICU who received a central line or peripherally inserted central line. Chart reviews audited electronic record documentation compliance with the five central line key components (hand hygiene, maximal barrier precautions, chlorhexidine skin antisepsis, optimal catheter site selection, and daily review of line necessity) to prevent CLABSI two months pre and post educational intervention. Patient charts were given a random number assignment for the audit and information was de-identified. Main Outcome Measures: The audit was used to produce pre and post intervention compliance rates with central line bundle documentation during the study period. A t-test, z-tests, and chi square test were used to determine if a significant change in the dependent variables, percentage of electronic medical record compliance rates for the five bundle components and CLABSI rates, pre-and post- educational intervention. The level of significance was established at p \u3c 0.05. Results: The study did not reveal any significant change pre and post educational intervention for daily review of line necessity (p = 0.0581), maximal barrier precautions (p = 0.36), chlorhexidine antisepsis (p = 0.36), hand hygiene (p = 0.47), or CLABSI rates (p \u3e 0.05). Conclusion: This study did not reveal any significant change in documentation compliance or CLABSI rates. However, future studies could help provide evidence to the effectiveness of central line bundle educational interventions in the ICU, as well as provide recommendations for streamlining documentation to increase compliance in nurses