Reducing the Incidence of CLABSI through Hand Hygiene

Abstract

Practice Problem: Central line-associated bloodstream infections (CLABSI) account for most hospital-associated preventable infections in the United States and globally. Implementation of effective hand hygiene practices is considered to be highly effective in preventing CLABSIs if performed during insertion and every handling instance. PICOT: The PICOT question guiding this project is as follows: Among intensive care unit employees (P), implementation of hand hygiene awareness program and practice (I) compared to current practices (C) in reducing CLABSI incidences (O) among adult inpatients in 10 weeks (T)? Evidence: The evidence from a rigorous literature review showed that the appropriate education promotes hand hygiene, direct observation of peer’s hand hygiene practice promotes hand hygiene, and various campaigns on hand hygiene improve compliance and implementation of the appropriate guideline. Intervention: The intervention for the change project included developing ICU staff nurses' competency and compliance in hand hygiene before and after handling patients with central lines. The intervention implemented was WHO’s five moments of hand hygiene technique for effective hand hygiene. The project manager directly monitored and remediated employees for hand hygiene breaches. Outcome: There was no statistical significance in the intervention but there was noted clinical significance. There was a slight change in CLABSI rates after implementing the WHO's five moments of hand hygiene technique. Reported CLABSI incidence before project implementation was 1 compared to zero incidences in the post-implementation period. However, the intervention was unable to yield hand hygiene compliance of 90% showing no positive effects on the compliance rates and hence deemed unsuccessful. Conclusion: The project outcome warrants additional monitoring with additional champions to audit the hand hygiene process. The outcome also warrants additional monitoring on larger sample over longer duration to yield more statistically significant data. Further staff education and training paired with periodic audits and evaluation of the practice change over time may add insights to more evidence of clinical significance.