Congress Abstracts 2006

90

SEQUENTIAL INTERVENTION STRATEGY DIRECTED AT REDUCING BSI IN THE HOSPITALIZED ONCOLOGY POPULATION IMPROVES NURSING KNOWLEDGE AND PRACTICE. Suzanne McGettigan, MSN, CRNP, AOCN^®, Deana Potts, MSN, CRNP, AOCN^®, Mika Epps, MSN, RN, and Mauri Sullivan, MSN, RN, Hospital of the University of Pennsylvania, Philadelphia, PA.

Catheter-Related Blood Stream Infections (CR-BSI) increase patient morbidity, mortality, length of hospitalization (LOS), and costs. Ninety percent of CR-BSI are associated with central venous catheters (CVCs). A hospital wide initiative was instituted at this academic medical center to reduce the incidence of CR-BSI; however, that program did not specifically address the unique needs of oncology patients. Hospitalized oncology patients are a high risk/ high volume population due to receipt of immunosuppressive therapies, prolonged neutropenia, multi-lumen catheters, and disruption of skin integrity by high dose chemotherapy regimens. CR-BSI rates have been reported as high as 13.62 per 1000 catheter days in stem cell transplant recipients. Educational programs have proved successful in decreasing the CR-BSI incidence.

The purpose of this intervention was to increase nursing knowledge and improve nursing practice thereby improving the nursing-sensitive patient outcome of CR-BSI.

Unit-based CNSs from two oncology units convened a multidisciplinary Oncology BSI Team. CNS observed clinical practice of staff nurses and convened focus groups to identify "problem areas." CNSs developed a sequential intervention consisting of educational and environmental components. The educational program focused on oncology-specific risk factors, identified "problem areas," and hands on practicum. The environmental modification brought supplies to the point of care. Staff nurses anonymously completed written tests evaluating knowledge and practice before and after the intervention.

Nursing Knowledge and Practice were evaluated using a pre-test/post-test format with multiple-choice questions assessing knowledge and a Likert Scale assessing practice compliance. Observation of clinical practice and associated documentation was performed prior to and following the intervention. Self-reported nursing knowledge improved from 73% to 88%; practice improved from 86% to 93%.

CVCs are essential for the comprehensive care of hospitalized oncology patients for the administration of IV fluids, medications, chemotherapy, and blood products. Oncology patients have many risk factors for the development of CR-BSI and require meticulous care of their CVCs. CR-BSI are known to increase treatment-related mortality; transplant recipients with infections have higher mortality rates and LOS. Oncology nurses are the caretakers of patients' CVCs. They must be knowledgeable and effective at maintaining CVCs and preventing CR-BSI.