Nursing and Supply Chain as Critical Partners in Enterprise-Level Efforts to Prevent Hemodialysis Associated Central Line-Associated Blood Stream Infections: A Case Study.

Abstract

Background: Preventing central line-associated bloodstream infections (CLABSIs) remains a critical national focus for health care facilities. This notion is particularly true for patients undergoing hemodialysis (HD), where the associated mortality rates for HD-CLABSI range from 12% to 25%. Studies show that the use of central venous catheter (CVC) end caps coated with antiseptic agents, such as chlorhexidine gluconate (CHG) on HD-CVCs, can reduce the incidence of CLABSIs. However, issues ranging from difficulty finding and maintaining an adequate (and fully standardized) supply of CHG-impregnated HD end caps and ensuring consistent practice by clinicians can prevent the use of this valuable tool. The purpose of this study is to discuss the implementation and lessons learned from a successful collaboration between supply chain and nursing standardization of the supply of CHG-impregnated HD-CVC end caps in more than 140 United States-based hospitals.

Methods: The 3-year, enterprise-wide initiative to standardize supply and end cap practice as well as reduce HD CLABSIs involved 3 phases: (Phase I) piloting the change in 5 inpatient facilities; (Phase II) implementing and scaling the change across 140 hospitals; and (Phase III) stabilizing supply and hard-wiring practices.

Results: Following the pilot, access to CHG-impregnated HD-CVC end caps increased more than 100-fold over the next 4 quarters, with more than 50 000 CHG HD-CVC end caps being available for use by the end of 2022. Throughout the process, review and real-time audit of HD-CVC end cap application and removal were used to standardize the practice. The review of CLABSI data over the course of the program showed a nearly 16% reduction in HD-CLABSI events per 1000 catheter days following standardization of HD-CVC end cap supply.

Conclusion: Overall, our results suggest that standardizing the supply of HD-CVC end caps (which are a critical link in the infection prevention chain) was associated with a reduction in CLABSIs among patients undergoing HD. In addition, the close collaboration between supply chain and nursing was instrumental to the success of our endeavor and may serve as a model for other health systems wanting to pursue similar efforts.