273. Prevention of CLABSIs: More than an Inpatient Problem
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
  • IDweek poster.JHA.pdf (508.4 kB)
  • Background: Central line-associated bloodstream infections (CLABSIs) are a major contributor to healthcare-acquired infections and cause significant morbidity and mortality. Although success has been achieved with multi-faceted prevention campaigns in decreasing inpatient CLABSIs, little has been done to evaluate central venous catheter (CVC) care in the ambulatory setting. Our project aims to investigate and standardize ambulatory CVC care for patients discharged from the hospital. As a first step, we surveyed home health (HH) nurses on their current knowledge and practices related to CVC care.

    Methods: Secure surveys were emailed to 72 nurses and managers from 8 HH agencies. The survey addressed CVC education, protocols for accessing CVCs, dressing and tubing changes, CLABSI surveillance and quality improvement. The data was de-identified and analyzed descriptively.

    Results: 44 (61% response rate) surveys were completed by field RNs (64%), clinical supervisors (27%) or other HH staff (9%). 48% of the respondents had greater than 10 years’ experience in HH nursing and on average the respondents cared for 16 patients per week. 98% reported their HH agency had a protocol for CVC care. 74% believed that everyone cared for CVCs in a standardized way. 76.2% reported that their agency had a protocol for when to remove CVCs. With regards to CVC dressing changes, 93% reported changing transparent dressings every 7 days; 14% reported changing gauze dressings every 2 days; 64% reported changing dressings if the dressing was “soiled, loose, or damp” and 59% reported changing dressings when there was a concern for infection. 10% correctly identified all 4 indications to change a CVC dressing.  69% thought their HH agency tracked rates of CLABSIs; 23% endorsed knowing the CLABSI rate. 89% reported they wanted more education on CVC care.

    Conclusion: A majority of HH nurses endorsed wanting additional education on CVC care. Our survey results highlight specific areas for improvement including ensuring all HH employees follow a protocol for CVC care and removal, improving knowledge on when to change CVC dressings, and instituting accurate CLABSI surveillance programs. Future directions include direct observation of HH nurses and analyzing readmission rates for patients discharged with CVCs.

    Jessica Howard-Anderson, MD, Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, Jonathan Grein, MD, Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA, Rekha Murthy, MD, FIDSA, FSHEA, Hospital Epidemiology, Cedars-Sinai Health System, Los Angeles, CA and Zachary Rubin, MD, Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, CA


    J. Howard-Anderson, None

    J. Grein, None

    R. Murthy, None

    Z. Rubin, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.