Implementation and Evaluation of a Central Line Associated Bloodstream Infection Bundle in the Pediatric Emergency Room: An Evidence-Based Quality Improvement Project

Abstract

BACKGROUND: Central line-associated bloodstream infections (CLABSI) pose a significant risk to pediatric patients in acute care settings. CLABSIs are associated with increased costs and increased mortality and morbidity. CLABSI bundles correlate with a decrease in CLABSI infections.

LOCAL PROBLEM: An increase in number of CLABSI infections was reported in the pediatric ER at the project site. This DNP project aimed to implement CLABSI bundle protocols and provide staff education to decrease CLABSI infections.

METHODS: Evidenced-Based Practice Improvement (EBPI) model was used to develop this evidence-based project.

INTERVENTIONS: Pre-test was given to gauge pre-implementation knowledge of bundle protocols and baseline competency. Education on CLABSI bundle protocols was provided through in-person training and an educational video. Port access checklist was used for infection prevention when accessing ports. Nurses accessed ports using two-nurse approach and used an audit tool to verify adherence to CLABSI bundle protocols. Post-test was provided to evaluate final knowledge and competency after CLABSI education. Outcome measure was the number of infection lines from the ER before and after implementation. Process measure was adherence to the CLABSI bundle checklist.

RESULTS: Pre- and post- test surveys were obtained to assess knowledge and level of competency in the CLABSI protocol. Post-intervention survey revealed that 0% of nurses reported they were no competent, 30% reported somewhat competent, and 70% reported extremely competent. Change for extremely competent pre- and post- test was 64.7% (P

CONCLUSIONS: Nurses increased their knowledge and competency in implementing the CLABSI bundle in the pediatric ER. This project improved patient care and decreased CLABSIs in patients from the pediatric ER. For sustainability, project results will be provided to hospital leadership for the use of the CLABSI bundle in all hospital departments.