A multidisciplinary comprehensive nursing Management Approach for Catheter-related bloodstream infections

Abstract

Background: Catheter-related bloodstream infection (CR-BSI) stands as one of the leading causes of hospital-acquired infections, often resulting in high healthcare expenditure and mortality rates. Despite efforts, reducing the incidence of CR-BSI remains a significant challenge.

Objective: This study aimed to assess the impact of a multidisciplinary organizational intervention on reducing intravenous CR-BSI.

Methods: A quality improvement team was established to implement various interventions, utilizing the FOCUS-PDCA continuous quality improvement model and fishbone diagram for analysis and improvement.

Results: After the interventions, operational indicators for catheter insertion, maintenance, and removal improved from 82.50% ± 1.15%, 83.60% ± 1.60%, and 81.60% ± 1.80-95.30% ± 1.00%, 96.20% ± 1.62%, and 97.25% ± 0.50%, respectively. Additionally, catheter dwell time decreased from 7.50 ± 0.85 days to 3.50 ± 0.75 days, and the quarterly infection rate was reduced from 2.328% ± 1.85-0.305% ± 0.95% following the implementation of the intervention.

Discussion: Despite the available evidence, there remains a noticeable gap between the ideal evidence-based practices and their practical implementation. We aim to eradicate CR-BSIs within the surgical intensive care units (ICUs) of hospitals. To achieve this goal, we have introduced a comprehensive quality improvement framework designed not only to benefit our own ICU but also to serve as a model for implementation in other similar healthcare settings.

Keywords: Central venous line; Continuous quality improvement; General surgical nursing departments; Nosocomial infection; Organizational creativity.

Fig. 1

Strategies for CQI. A. Formation of an interdisciplinary team. The interdisciplinary team consists of a general surgery leader, an infectious disease specialist, an anesthesiologist, frontline staff, and a CQI expert B. Identification of risk factors for catheter insertion, routine maintenance, and removal. The team compiled a list of risk factors associated with catheter usage by reviewing relevant literature on CR-BSI C. System process map for catheter use. We developed a comprehensive process map to measure real-time catheter use and CQI. Routine Extraction/Removal: This is performed when treatment is no longer needed or when the catheter has expired. Non-routine Extraction/Removal: This is performed due to suspected infection, catheter-related complications, or catheter damage

Fig. 2

Fishbone Diagram of the Comprehensive Evaluation Framework for CR-BSI. The fishbone diagram represents the potential causes of CR-BSI, encompassing the categories of environment, materials, personnel, and/or practice protocols

Fig. 3

Effects of CQI. A. Surgical scoring for insertion, maintenance, and removal. The improved surgical scoring is higher compared to the pre-improvement period. The scores are calculated using specialized tables (Supplementary files 2-4). A higher score indicates a more standardized operation. B. Adherence to hand hygiene protocols among nursing staff and anesthesiologists. The level of adherence to hand hygiene practices among nursing personnel and anesthesiologists is higher after the improvement. C. CDT. The improved CDT is shorter than before. Data is expressed as the mean value with its corresponding standard deviation. (*P<0.05). D. Quarterly average infection rate. The improved quarterly average infection rate is lower than before. Data is expressed as the mean value with its corresponding standard deviation. (*P<0.05) GSD, General Surgery Department; OD, Other Departments

Fig. 4

Overview of CR-BSI in our hospital A. Number of infections in various departments, including General Surgery. More than half (51–68%) of the infection events occurred in the General Surgery nursing unit B. Association between the number of insertions and bloodstream infections and the duration of CDT. The peak occurrence of infections was within 5 to 7 days of catheter placement C. Reassess catheter insertion, maintenance, and removal processes, comparing them to the infection rates from the National Database of Nursing Quality Indicators. To further mitigate infection rates, we aimed to reassess catheter insertion, maintenance, and removal processes, comparing them to the infection rates from the National Database of Nursing Quality Indicators (NDNQI). Higher infection rates were observed with a dwell time of 3–20 days. Quarterly infection rates for 2015–2017. Before improvement, the infection rate in the General Surgery department was significantly higher than that of NDNQI. After the interventions, the infection rate in the General Surgery department was lower than the NDNQI rate