An appetite for improvement: Reducing the incidence of bloodstream infections in patients receiving parenteral nutrition via a central venous catheter

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Background & Problems

A bloodstream infection (BSI) is a recognised risk associated with parenteral nutrition (PN) administered via a central venous catheter (CVC). It can be life-threatening, leads to an extended hospital stay and, for patients reliant on PN, it can mean 7-14 days without nutrition. NICE estimate that the cost of each catheter-related BSI is £9,000.

Aim

50% reduction in the incidence of BSI associated with a CVC in patients receiving PN in an adult ward by end of 2018.

Method

The BSI rate is recorded each month and the number of days of PN administered each month is used as a balancing measure to allow fair comparison of monthly BSI rates. A Root Cause Analysis tool (RCA) was developed to investigate each BSI. Findings from each RCA were reported to the relevant ward manager to highlight areas which could be improved and guide action planning on the ward. The most commonly occurring factors from the RCAs showed us where improvement ideas should be focused. Pop-up ward based teaching sessions for nursing staff were used to highlight the risk factors for patients developing a BSI and clarify best practice for management of CVC and PN. We worked with the Vascular Access team to change the type of CVC used for PN to one which reduces the risk of infection. In a small number of patients who required PN for more than 28 days, we trailed the use of a protective cleaning cap on the CVC.

Results

We have made a 49.6% reduction in BSI rates so far in 2018. We are on track to meet our target of a 50% reduction.

Implications

The RCA findings have shown that there are a number of factors which contribute to a patient developing BSI. This means a number of different strategies are needed to improve BSI rates.

Future work includes:

• develop an e-learning module for PN
• trial some ward-based Care of CVC update training for nurses

This improvement programme has focused on BSI in patients receiving PN but it could also be applied to improving the care of all CVCs in all our patients.