Ms Suzanne Alexander1, Miss Carmel Couch1
1Illawarra Shoalhaven Local Health District, Wollongong, Australia
Eight cases of Central Venous Access Device (CVAD) related blood stream infections were identified in patients attending a 600 bed tertiary referral hospital from March to May 2018. Baseline rates were low up until this time.
A multi-disciplinary working party was established to review CVAD management and to explore opportunities for improvement. A number of strategies were implemented and evaluated.
An audit of CVADs highlighted poor compliance with management of Central lines. It was noted that junior medical officers were regularly accessing CVADs and PICC lines for routine blood collection with no training.
Prior to the implementation of any improvement strategies, an online survey was undertaken with 198 respondents. Strategies implemented to improve compliance were:
- Junior doctor training in appropriate access/documentation of CVADs
- Improved access to CVAD-related equipment
- CVAD equipment poster developed
- Aseptic non-touch technique and CVAD management updates for Clinical Nurse Educators prior to rolling out education packages.
- Orientation for new staff including CVAD management, equipment resources
Incidence of CVAD BSI was continuously monitored throughout
The online survey was repeated after six months with 173 respondents to assess any changes in theoretical knowledge and practice. Comparison of the pre-implementation and post-implementation survey results showed improved documentation, increased knowledge in when to change dressing, reported improved access to equipment and improved awareness of how to access CVAD resource people.
Since these initiatives were introduced, the number of CVAD- related bacteraemias have returned to pre-incident numbers of one every few months.
Suzanne has a background of acute and community health nursing. She has been working in Infection Control since 2001. Suzanne has worked as an Infection Prevention and Control CNC in regional and remote areas in community, rehabilitation and acute settings.