Hospitals are always looking for new ways to reduce costs. Hospitals and researchers began looking at catheter-related bloodstream infections (CRBSIs). Their studies show that CRBSIs add many unnecessary costs that could be prevented in the first place.
CRBSIs could be reduced or even prevented if hospitals establish strict guidelines for healthcare workers to follow. Some hospitals do not have standardized practices regarding central venous catheter care (CVC). In some hospitals, CVC care is done according to the doctor's preference.1
Researchers have tested certain interventions for effectiveness in reducing CRBSIs. They studied the infection rates before and after implementing their interventions. They found that certain interventions dramatically reduced the rate of CRBSIs. Through researching CRBSIs, hospitals have made great improvements toward reducing CRBSIs, which has in turn reduced costs.
CRBSIs are a huge problem in hospitals. One study found that there are as many as 80,000 catheter-related bloodstream infections (CRBSIs) per year.1
The complications related to CRBSIs lead to increased length of stay for patients. This study showed that after the implementation of strict guidelines regarding CVC care, there was a significant reduction of length of stay for patients in the ICU. When nurses and other healthcare workers implemented the evidence-based interventions, patients' length of stay was reduced to approximately 12.11 ± 1.46 days. Patients who did not receive the recommended CVC care guidelines stayed in the hospital for about 18.6 ± 1.51 days.1 (Duane et al., 2009). Each day spent in this particular ICU costs about $7,249.1 By using practices that reduce CRBSIs, this hospital saved an average of $43,494 per patient.
Before the implementation of evidence-based interventions, the hospitals in the studies lacked standardized practices or utilized outdated ones that created environments in which CRBSIs flourished. Specific interventions that contribute to a decrease in CRBSIs.
- Hand hygiene is the easiest and most obvious way to prevent the spread of germs.
- Require all members of the healthcare team to use maximum barrier precautions when working with any central line insertion site.2
- Rub the central line's ports vigorously for 5-10 seconds with 70 percent isopropyl alcohol before administer medications was another simple yet invaluable intervention.3
- The central line's insertion site also must be checked daily to ensure that no signs of infections are present. It also is important that the dressing be changed once every 7 days or sooner if it appears dampened, loosened or soiled.1
- Compliance! These intervention mean nothing if they are not followed. Some hospitals have ensured compliance by having one-on-one training sessions at the bedside with nurses.4
Not only is it important to have standardized protocols, it is also important for nurses to have premade CVC kits and use them properly. These kits should include ChloraPrep, Biopatch, Tegaderm and sterile gloves.3 These products should be used as followed. Once the old Tegaderm is removed with clean gloves, dispose the gloves and follow sterile technique.
First, set up the sterile field is set up and don sterile gloves. The area of insertion is cleaned for 30 seconds with Chloraprep.2 It is important to start near the area of insertion and slowly, in a circular fashion, clean outward from the insertion site.
Allow the area to air-dry for 30 seconds. Do not blow on the insertion site to make it dry faster. This exposes the site to more germs.
Once dry, apply the Biopatch directly above the insertion site. The shiny side of the Biopatch should be facing up and the catheter should be going through the center of the Biopatch. Cover the insertion site with Tegaderm and sign and date it. These are the items that are essential to a CVC kit and must be used correctly.
Following these protocols and developing this CVC kit have yielded amazing results. One hospital implemented these steps and achieved a zero CRBSI infection rate for 15 consecutive months.3
Numerous studies show that these guidelines decrease the length of stay for patients. Decreasing patients' length of stay saves thousands of dollars in healthcare costs. It is time for the healthcare team to be proactive when dealing CVC care and adhere to these guidelines. As healthcare costs continue to rise each year, the time for hospitals to change their policy is now.
1. Duane, T., Brown, H., Borchers, C., Wolfe, L., Malhotra, A., Aboutanos, M., et al. (2009). A central venous line protocol decreases bloodstream infections and length of stay in a trauma intensive care unit population. American Surgeon, 75(12), 1166-1170.
2. East, D., & Jacoby, K. (2005). The effect of a nursing staff education program on compliance with central line care policy in the Cardiac Intensive Care Unit. Pediatric Nursing, 31(3), 182.
3. Harnage, S. (2007). Achieving zero catheter related blood stream infections: 15 months success in a community based medical center. Journal of the Association for Vascular Access, 12(4), 218-224.
4. Miller-Hoover, S., & Small, L. (2009). Research evidence review and appraisal: pediatric central venous catheter care bundling. Pediatric Nursing, 35(3), 191-201.
Jeremy Arcaira & Rai Claronino are nursing students at California State University San Bernardino. Additionally, Marilyn Stoner, PhD, RN, CHPN, associate professor of nursing at CSUSB, advised the authors in preparing this article.