Blood Stream Infection Prevention Best Practice Team

The Blood Stream Infection Prevention Best Practice Team focused on blood stream infections related to the presence of central lines in the ICU. In September 2006, when this team was formed, there were 11 ICUs in our institution. Five (5) of the units ranked within the top 10th percentile in the National Nosocomial Infections Surveillance database which provides the infection control benchmarks. While the remaining units were still well below the 50th percentile, four (4) reported rates at just above the 25th percentile. This inter-disciplinary team consisted of members from nursing staff, nurse managers, infection control practitioners, a critical care CNS, nurse researcher, and IV therapy nurse. Through use of an evidence based practice model, the team conducted an extensive literature review. The synthesis of the review of the literature was compared to the current policy and procedures regarding insertion and care of central lines. The practices of the ICUs that ranked within the top 10th percentile were also evaluated for best practice. The BSI Best Practice Team found that in comparing policy to best practice, there were only two minor revisions that needed to be made. The policy was revised to include regular “dead end” cap changes and remove the practice of placing a 2x2 gauze over the insertion site underneath the clear dressing. A critical step missing in practice was the empowerment of the bedside nurse to stop the procedure of insertion if any step in the proper process was omitted. A checklist was used to empower the nurse to assess and intervene if necessary. The ICU with the lowest infection rate used a sign to indicate the day the dressing needed to be changed. These were adopted in all the ICUs. The BSI rates are reported monthly. The rate has improved and remains well below the benchmark.