DOI

10.21007/con.dnp.2025.0106

Faculty Advisor

Tracy McClinton, DNP, APRN, AGACNP-BC, HGET-C, EBP-C and Margaret Harvey, PhD, APRN, ACNP-BC, CHFN, FHRS

Document Type

Poster

Publication Date

Spring 4-23-2025

Disciplines

Analytical, Diagnostic and Therapeutic Techniques and Equipment | Bacterial Infections and Mycoses | Critical Care Nursing | Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Nursing Administration | Quality Improvement

Abstract

Purpose/Background

In the Intensive Care Units (ICU), central lines are an essential way of life. However, central lines have risks such as central line-associated bloodstream infections (CLABSI), which increase hospital stays and mortality. CLABSI significantly impacts patient outcomes in critical care, increases mortality and morbidity, increases medical costs, increases hospital-acquired infections, and reduces hospital reimbursements. Typically, antimicrobial dressing has been associated with decreased mortality and improved CLABSI rates. The scoping review will evaluate the literature and examine the effectiveness of various antimicrobial dressing strategies on CLABSI rates. This study aims to synthesize these findings to develop improved CLABSI prevention protocols in ICUs, ultimately enhancing patient outcomes.

Methods

Following PRISMA guidelines, a literature review was performed from August 2022 through December 1, 2024, synthesizing research published within the last five years. Articles were selected based on their relevance. Individual searches of Clinical Key, Elsevier, Cochrane, NCBI, CDC, LBM, and Washington Medical Therapeutics were completed using the following keywords: “adult patients hospitalized with CLABSI,” “dressing change protocol,” “no protocol,” “affect the incidence of CLABSI,” “in the intensive care unit,” “central line infection,” dressing changes,” “dressing change protocol,” and “CHG.” Out of eighteen potentially appropriate articles, a rapid critical appraisal and in-depth discussion of these articles yielded a final section of 8 articles. The goal was to note that proper CVAD dressing changes reduce CLABSI rates.

Results

Building on Paquet et al. (2019), who transitioned from CHG-impregnated dressings to dry dressings without increasing CLABSI rates, we emphasize the need for a structured dressing change protocol. Webster et al. (2017) found no significant difference in CLABSI rates between CHG and PHMB dressings, attributed to their existing dressing bundle.

Research by Pook et al. (2022) suggests CHG locking solutions are more effective than standard methods for reducing bacterial growth. Mitchell et al. (2020) demonstrated the benefits of sutured central lines with CHG discs and integrated securement devices. Wei et al. (2021) reported a 68% decline in CLABSI due to comprehensive protocols, while Hunger et al. (2020) and Reynolds et al. (2021) emphasized the importance of adherence to established protocols for reducing rates. Conversely, Yu et al. (2019) found that CHG dressings did not significantly decrease CLABSI rates despite less frequent dressing changes.

Implications for Nursing Practice

This scoping review underscores the importance of standardized central line dressing change protocols in reducing CLABSI rates and improving patient outcomes in ICU settings. Nurses and nursing staff are pivotal in implementing and adhering to these protocols. The findings suggest that continued refinement and compliance with dressing change protocols, particularly CHG dressings, should be prioritized to enhance patient safety, reduce infection- related complications, and shorten hospital stays. Future research should focus on the optimal design and long-term outcomes of various dressing change protocols to further inform best practices in ICU settings.

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