Impact of Support Teams on Central Line Insertion

A new report published in the American Journal of Infection Control (AJIC) shows that deploying a dedicated team of nurses to assist with central line insertions can reduce the risk of patients developing bloodstream infections from those central lines. In this report, UNC Health infection prevention specialists found that having this dedicated team reduced the proportion of central line-associated bloodstream infections that occur within seven days of line placement by 47 % among patients included in this program.

Central lines, or central venous access devices, are alternatives to standard intravenous lines used for hospitalized patients who are critically ill or need long-term treatment. They are more invasive than intravenous lines and are associated with a higher risk of bloodstream infections; In the US, more than 28,000 deaths a year are attributed to these types of infections. Clinical guidelines offer specific protocols to ensure proper insertion of a central line, but an internal study of UNC Health providers found that more than 80 percent of insertions did not follow all recommended practice standards.

At UNC Health in Chapel Hill, North Carolina, infection preventionists and hospital leaders set out to improve patient outcomes by establishing a dedicated nursing team to assist with central line insertions. The team was tasked with confirming compliance with a clinical checklist, observing and enabling infection prevention techniques, and ensuring the availability of supplies needed for the procedure.

To measure outcomes, they focused on bloodstream infections that occurred within a week of line placement, as this is the time period in which infections are most likely to be related to the insertion process. . In the first three years of the program, the proportion of bloodstream infections associated with central lines in this one-week period decreased by 47% among patients whose line insertions were supported by the specialized nursing team.

"While previous studies have demonstrated the effectiveness of having dedicated teams perform central line insertions, there was surprisingly little information available on the use of specialized support teams for this important procedure," said Shelley Summerlin-Long, MPH, MSW, BSN. , RN, senior quality improvement leader in the Department of Infection Prevention at UNC Health and lead author of this study. “We were eager to evaluate whether having a dedicated nursing team to observe and help would make a difference in patient outcomes at our hospital. “The decrease in related infections by 47% during the team’s first three years is notable and provides clear validation of this approach.”

The UNC Health study was conducted between February 2019 and March 2022. The dedicated team of 4.5 full-time nurses provided around-the-clock support for central lines inserted at the bedside of hospitalized adult patients .

The results show:

After an acceleration period during the first year of the initiative, the nursing team routinely assisted with 110 to 120 central line insertions per month in the second and third years of the program.
When the program began, an average of 60 central lines were placed each month without requesting assistance from the specialized team. By the third year of the program, that number had decreased to 44 insertions per month.
Over the three-year period, the overall proportion of bloodstream infections associated with central lines remained stable in the hospital. Within that, the proportion of such infections among patients whose insertions were assisted by the nursing team decreased from 19% before the implementation of the program to 10% in the third year, for an overall reduction of 47%.
The team also conducted audits of more than 100 central lines each month and offered training to frontline staff in 90% of cases.

“Decreasing bloodstream infections associated with central lines improves quality of care and saves lives,” said Patricia Jackson, RN, BSN, MA, CIC, FAPIC, president of APIC 2023. “The innovative approach described in "This study shows that adding trained observers to assist with central line placement has enormous potential to reduce infections and prevent harm."

Reference:

“A Helping Hand: The Impact of a Central Line Insertion Support Team,” by Shelley K. Summerlin-Long, Lauren M. DiBiase, Melody Padgett, Jennifer Mack, Christa Clark, Lisa Teal, and Emily Sickbert-Bennett was published online in AJIC on October 19, 2023. Available at: https://doi.org/10.1016/j.ajic.2023.09.004

Impact of Support Teams on Central Line Insertion

Reduced bloodstream infections associated with central lines underscore the importance of support teams in improving patient care and outcomes.