Year of Publication

2019

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Leslie Scott

Clinical Mentor

Chris Donaghey

Committee Member

Dr. Nicole Garritano

Committee Member

Dr. Debra Hampton

Abstract

PURPOSE: Central line associated blood stream infections pose a threat to patient safety and are costly to healthcare systems. Heath care professional frequently access central venous access device (CVAD) to obtain blood samples for laboratory analysis. A commonly accepted procedure practice involves exchanging 3-4 syringes during the collection process. Each time a syringe is exchanged during the lab collection process the opportunity for bacteria to be introduced into the bloodstream exists. Decreasing the number of times a CVAD is accessed removes opportunities for bacteria to be introduced to the line thus decreasing the risk of infection. Due to the occurrence of CLABSI on a pediatric hematology/oncology (hemonc) unit, a practice change employing the use of stopcocks to reduce the frequency of direct access to the CVAD was implemented in 2013. The purpose of this project was to evaluate the stopcock method practice used for lab collections from CVAD among children on a pediatric hemonc unit. The goal of this evaluation is to determine if the implementation of the stopcock reduced CLABSI rates.

METHODS: A retrospective pre/post implementation design was used to evaluate the use of the stopcock method for lab collection. The data analysis involved comparing infections rates prior to implementation of the stopcock method to infection rates collected after its implementation. This project design is quantitative in nature as infection rates were compiled for comparison and analysis.

RESULTS: Monthly unit CLABSI rates were reviewed for patients admitted over a 10-year span (2008-2018). The data showed an increase in overall CLABSI rates after the initiation of the stopcock. The infection rates prior to the initiation of stopcocks ranges from 26.7-41 with an average of 31.4 for the 5 pre-years assessed versus 35.7-52.9 with an average of 43.2 for the 6 post-years assessed.

CONCLUSION: The 10-year data review revealed CLABSI rates increased on the hemonc unit after the introduction of the stopcock apparatus use for lab collection. However, this study uncovered a number of confounding variables such as the lack of a standardized practice protocol. These confounding variables limit the conclusiveness of the study findings. Further research is recommended in order to determine the best practice for lab collections from CVADs.

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