Congress Abstracts 2006

143

DECREASING THE MORBIDITY ASSOCIATED WITH CENTRAL VENOUS CATHETERS IN THE BONE MARROW/STEM CELL TRANSPLANT PATIENT POPULATION. Melissa Bennett, RN, BSN, OCN^®, and Marilyn Bedell, MS, RN, OCN^®, Norris Cotton Cancer Center/Dartmouth Hitchcock Medical Center, Lebanon, NH.

Central venous catheters (CVC) are essential technology used in the bone marrow/stem cell transplant (BMT) patient population. Decreasing CVC infections is a high priority in transplant care.

The purpose of this quality improvement project was to minimize CVC infections and related complications by improving the process of selection, placement and follow-up care for CVCs in the BMT patient population. The process began with the decision for the patient to undergo transplant and ended when the catheter was no longer medically necessary.

Three interventions were initiated. The first intervention was to standardize the ordering process for CVCs. The second intervention was to complete direct observations of both placement of CVCs and dressing change techniques. This was done to identify variation in practice based on Center for Disease Control and Prevention (CDC) guidelines. The third intervention was to implement the use of an antimicrobial dressing as well as ensure the ongoing use of CDC guidelines.

On January 1, 2005 new care standards were officially implemented. Currently, 32 CVCs in BMT patients have been tracked. The goal is to evaluate care of 52 BMT patients. To-date there have been no CVC infections identified. A retrospective review of 52 CVCs in BMT patients prior to January 1, 2005 showed a CVC associated blood stream infection (BSI) rate of 17.1 BSIs per 1000 catheter days.

This quality improvement project highlighted the importance of evaluating current practice assumptions, providing direct feedback about practice to clinicians, and achieving consensus about practice guidelines as a means to dramatically decrease infection rates.