By: Cassaundra Braden

Ferris State University

A central line is a tube that is placed into a patients large
vein, usually in the neck, chest, arm, or groin. The catheter is
often used to draw blood, or give fluids or medications. It may
be left in place for several weeks. A bloodstream infection can
occur when bacteria or other germs travel down a central
line and enter the blood.

This project is meant to increase awareness of central line
associated blood stream infections (CLABSI) and ways to
decrease occurrence.

Disinfectant caps have recently been included in practice
recommendations from major infection control organizations
including: SHEA, IDSA, AHA, APIC, and The Joint
Commission.

Goal:
Introduce disinfectant
caps to the progressive
care and intensive care
units of Metro Health
Hospital by July 18
th
in
order to reduce the rate
of CLABSIs and decrease
costs associated with
infections while
increasing patient safety
and satisfaction.
Objectives:
Present information on
disinfectant caps to IV team at
Metro Health Hospital by June
14
th

Provide evidence based
research along with data from
surrounding hospitals on
infection rates with and without
alcohol caps to Infection
Prevention (IP) by July 12
th

Consideration of
implementation of disinfectant
caps by Metro Health Hospital
by July 18
th
.

The Joint Commission
National Patient Safety Goal #7 Reduce the risk of health
careassociated infections.

The use of disinfectant caps helps hospitals meet TJCs
recommendation for a standardized protocol to disinfect catheter
hubs and injection ports that can be monitored for compliance.

American Association of Critical-Care Nurses
Standards of Professional Performance #1- Quality of
Practice

The nurse develops, implements, evaluates, and updates
policies, procedures, and/or guidelines to improve the quality
and effectiveness of nursing practice.
(The Joint Commission, 2014), (AACN, 2008)
0
0.2
0
0.76
0
0.83
1 1
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
2.2
2.4
2012 2013
S
t
a
n
d
a
r
d
i
z
e
d

I
n
f
e
c
t
i
o
n

R
a
t
i
o

(
S
I
R
)

CLABSI / ICU
Metro
Michigan
National
SIR
(Metro Health Hospital, 2014)
CLABSI/ICU 2012 2013 2014
Metro 0 0.2
Michigan 0 0.76
National 0 0.83
SIR 1 1
Metro Health Hospital does
not currently utilize
disinfectant caps for central
line infection prevention.
2014


Number of
CLABSI

UNIT Jan. Feb. Mar. Apr. May Jun Jul Aug Sep Oct Nov Dec
UNIT
TOTAL
A 0 0 0 0 0 0
B 1 0 0 0 1* 1
C 1 0 1 0 0 2
D 0 0 0 0 0 0
E 0 0 0 0 0 0
F 0 0 0 0 0 0
G 1 0 1 0 0 2
H 0 0 0 0 0 0
TOTAL 3 0 2 0 0 0 0 0 0 0 0 0
5
TOTAL
(Hospital X, 2014)
Hospital X is a nearby hospital that implemented disinfectant
caps in May 2014 after being determined to have 5x the
Standardized Infection Ratio (SIR) of CLABSI.
June 10
th
I was able to speak to the Unit Based Council about my
project and the benefits of including disinfectant caps for central line
infection prevention.

June 13
th
I met with IV team to discuss my project.

July 1
st
I corresponded with two different disinfectant cap distribution
companies via email regarding alcohol cap cost and statistics.

July 15
th
I spoke with the head of Infection Prevention (IP) about
initiating the use of disinfectant caps the hospitals infection
prevention policy.

August 12
th
is the next Value Analysis Team meeting where IP will
present disinfectant caps for consideration.
This project increased awareness of the risk of central
line infections on the progressive and intensive care
units. It was made evident that initiation of alcohol caps
would decrease or eliminate this risk. Before this project
the only staff that were aware of alcohol caps for central
lines were the two nurses on the IV team and the head
of IP. Very few staff knew the current policy on how long
to scrub the hub of central lines with alcohol wipes prior
to accessing.

All objectives were completed and the end goal will be
determined after the August 12
th
meeting of the Value
Analysis Team when IP presents the disinfectant caps for
consideration.

After commencement of the project it was made known
that disinfectant caps had previously been considered
and turned down by the Value Analysis Team due to cost
of supplying the hospital with caps and a CLABSI below
the SIR and national average.

Other obstacles include scheduling conflicts in meeting
with the head of IP and the August 12
th
meeting of the
Value Analysis Team being after completion of the
project.
One IV team nurse was not very receptive to the idea of
disinfectant caps and was uninterested in being included
in the project team.

The head of IP was very excited about TJC including
alcohol caps as a practice standard for infection
prevention but felt her hands were tied due to the Value
Analysis Teams view on cost of caps.

Patient safety should be of greater importance than
hospital cost.
The American Nurses Association
Scope and Standards of Professional Practice #12-
Leadership
The registered nurse demonstrates leadership in the
professional practice setting and the profession.

As a first time project manager everything was a learning
experience for me. I was able to establish goals that helped me
succeed. I learned that if you are confident in your project and
have the evidence based research to back it up, others will join
you in your enthusiasm. I used multidisciplinary collaboration in
order to guide my project toward a favorable outcome.
(ANA, 2010)

American Nurses Association (ANA) Scope and Standards
of Nursing Practice, 2010
American Association of Critical-Care Nurses. (2008)
Mission, Vision, Values, and an Ethic of Care. Aliso
Viejo, CA.
The Joint Commission. (2014). National Patient Safety
Goals. Retrieved July 16, 2014, from
http://www.jointcommission.org/standards_informatio
n/npsgs.aspx