Margaret Harvey, PhD, APRN, ACNP-BC, CHFN
Bacterial Infections and Mycoses | Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Quality Improvement
Central lines provide many benefits to critically ill patients; however, there are additional risks with them, including central line-associated bloodstream infections (CLABSIs). CLABSIs place patients at increased risk for morbidity and mortality, longer length of stay, and higher medical costs. Studies evaluating various methods of reducing CLABSIs have been performed. This scoping review was completed to determine the effectiveness of frequent central-line dressing changes and increased monitoring on the incidence of central-line associated blood stream infections in adults with central-lines.
An extensive database search through the University of Tennessee Health Science Center (UTHSC) Online Library was performed between September of 2019 and November of 2022. EBSCO/CINAHL, PubMed, Cochrane, and Scopus databases were utilized, using key terms: monitoring, CLABSI, dressing changes, central line, infection, bundle care, and central venous catheter. Of the 2,341 articles resulted, 15 articles were chosen based on relevance, results, and quality of the articles. Tables were created to identify levels of evidence and evidence outcomes.
Out of the fifteen articles selected, eight reported a decrease in CLABSI rates. Many facilities reduced their CLABSI rate while lowering frequency of CVC dressing changes. Increased CVC bundle compliance, CVC surveillance, improved documentation, and use of checklists contribute to these reduced rates, but confound the results.
Implications for Nursing Practice
The articles revealed that the utilization of CVC surveillance decreased CLABSI rates. It is unclear how the frequency of CVC dressing changes affects CLABSI rate. Most studies failed to mention dressing changes, and when mentioned, the frequency of dressing changes was reduced with continued reduction in CLABSI rate. Further studies isolating these variables is recommended.
Schmidt, BSN, RN, CCRN, Jacob; Brown, BSN, RN, Georgia; Dickey, AGPCNP-C, Laura; Faulkner, BSN, RN, Lauren; and Harvey, PhD, APRN, ACNP-BC, CHFN, Margaret , "The Effectiveness of Increasing Frequency of Central-Line Dressing Changes and Monitoring on CLABSI Rates: A Scoping Review" (2023). Doctor of Nursing Practice Projects. Paper 52. http://dx.doi.org/10.21007/con.dnp.2023.0052.