Education and Auditing to

Enhance Central Line Care Bundle

Alia Hajou

Azusa Pacific University

 Background
● Bundle-care ↓ CLABSI & eliminates correction costs (Aloush and Alsaraireh,
2018).
● CDC
○ 58% reduction in CLABSI rates since start of bundle care (2016).
○ 41,000 central line infections per year
■ 1 in 4 patients die (2016)
○ Average cost?
 PICOT Question
Among acute care nurses caring for patients with central line

catheters, does in-service training and procedure audits on

central line bundle-care, reduce hospital acquired central line

associated blood stream infections in patients by at least 50%,

compared to no in-services and audits, prior to and during

central line care?

 Key Findings
● Central line bundle-care procedures most effective to ↓ CLABSI rates (Sabo et al., 2018; Hakko et
al., 2015 and Barsuk et al., 2015).
● Emphasize entire sequence of bundle-care → following education, central line maintenance
adherence improved (Sabo et al., 2018).
● Nurse adherence to central line bundle-care protocol ↑ & CLABSI rate ↓ after intervention (Cherifi et
al., 2013 and Drews et al., 2017).
○ Bedside training
○ Simulation-based mastery learning
○ Lectures
○ Audits w/ performance feedback
 Hierarchy of Evidence

● Systematic Review
○ Level I - strong

● Randomized Control Trial

○ Level I - strong

● Quasi-Experimental
○ Level II - moderately strong

● Correlational
○ Level III - weak

(Davidson, 2018)
 Plan for change
Emphasis on education to implement the proper techniques and oversight to
ensure quality of central-line care.

● Acute care central line education program

○ Parallel methods from Barsuk et al. (2015)
■ Simulation-based mastery learning program
● New hire training & quarterly following
○ Bundle formulated based on CDC standards of care for central lines (Sahni et al., 2017;
Aloush and Alsaraireh, 2018).
■ Outcomes measured w/ Aloush and Alsaraireh (2018) compliance measurement sheet.
○ CLABSI rates monitored monthly
 Clinical Implications
● Need for education based learning of central line maintenance care
● Standardization
● New-hire training
● Consistent audits
Potential Barriers

● Requisite course for nurses?

● Funds

○ Costs to correct

● Pressure to Perform
 Expected outcomes

Education-Audit based central line bundle care will:

● Reduce CLABSI rate in acute care patients

○ Safety, satisfaction

● Increase staff knowledge on central line maintenance/care

○ Confidence, consistency

● Reduce unnecessary hospital costs

 Ethical & Spiritual Implications
● Beneficence
● Nonmaleficence
● Stress on patient
○ Already stressed due to chronic disease
○ Due to new infection
○ Trust of providers/nurses?
 Conclusion

● Synthesis of education and audit approaches

● Standardized central-line bundle

● Nurses play key role in advocating for themselves & their patients by receiving the best

possible education for skills, which ultimately determine health outcomes for the

patients

● By using standardized central line educational training and periodical/ consistent central

line care checks, nurses will decrease CLABSI rates and eradicate the ambiguity of

central line care.

Resources
Aloush, S. M., & Alsaraireh, F. A. (2018). Nurses’ compliance with central line associated blood stream infection prevention guidelines. Saudi Medical
Journal, 39(3), 273–279. http://doi.org/10.15537/smj.2018.3.21497

Barsuk, J. H., Cohen, E. R., Mikolajczak, A., Seburn, S., Slade, M., & Wayne, D. B. (2015). Simulation-Based Mastery Learning Improves Central
Line Maintenance Skills of ICU Nurses. JONA: The Journal of Nursing Administration, 45(10), 511-517. doi:10.1097/nna.0000000000000243

Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics. New York: Oxford University Press.

Cherifi, S., Gerard, M., Arias, S., & Byl, B. (2013). A multicenter quasi-experimental study: Impact of a central line infection control program using
auditing and performance feedback in five Belgian intensive care units. Antimicrobial Resistance and Infection Control, 2(1), 33-39.
doi:10.1186/2047-2994-2-33

Davidson, J. (2018). Levels of Evidence Worksheet. Unpublished Document through San Diego Evidence-Based Practice Institute.

Drews, F. A., Bakdash, J. Z., & Gleed, J. R. (2017). Improving central line maintenance to reduce central line-associated bloodstream infections.
American Journal of Infection Control, 45(11), 1224-1230. doi:10.1016/j.ajic.2017.05.017
Hakko, E., Guvenc, S., Karaman, I., Cakmak, A., Erdem, T., & Cakmakci, M. (2015). Long-term sustainability of zero central-line associated
bloodstream infections is possible with high compliance with care bundle elements. Eastern Mediterranean Health Journal, 21(4), 293-298.
doi:10.26719/2015.21.4.293

Hansen, S., Schwab, F., Schneider, S., Sohr, D., Gastmeier, P., & Geffers, C. (2014). Time-series analysis to observe the impact of a centrally
organized educational intervention on the prevention of central-line-associated bloodstream infections in 32 German intensive care units.
Journal of Hospital Infection, 87(4), 220-226. doi:10.1016/j.jhin.2014.04.010

Healthcare-associated Infections. (2016, March 01). Retrieved July 16, 2018, from https://www.cdc.gov/hai/bsi/bsi.html

Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for
nursing practice (9th ed.). Philadelphia: Wolters Kluwer Health/lippincott Williams &
Wilkins.

Sabo, K. B., Sickbert-Bennett, E. E., Kellish, A. A., & Smith-Miller, C. A. (2018). Assessing nurses adherence to a central line maintenance care
checklist on a pediatric inpatient unit. American Journal of Infection Control, 46(2), 221-222. doi:10.1016/j.ajic.2017.07.023

Sahni, N., Biswal, M., Gandhi, K., Kaur, K., Saini, V., & Yaddanapudi, L. (2017). Effect of intensive education and training of nurses on ventilator-
associated pneumonia and central line-associated bloodstream infection incidence in intensive care unit at a tertiary care center in North
India. Indian Journal of Critical Care Medicine, 21(11), 779-782. doi:10.4103/ijccm.ijccm_259_17