Researchers at Cincinnati Children’s Hospital implemented a quality improvement project to reduce unscheduled dressing changes and unnecessary dressing inventory for PICC lines and other central venous access devices. The results of this project included a decrease in unscheduled dressing changes, decrease in central line-associated bloodstream infections, standardization of dressing change procedure, and significant reduction in dressing-related costs.
Leigh Ann Bowe-Geddes
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Christopher Kramer, Darcy Doellman, Casey Blaser, Robin Huneke Rosenberg, and Stéphanie F. Bernatchez (2019) A Quality Improvement Approach in Standardizing Pediatric Central Venous Catheter Dressings and Its Impact on the Reduction of Central Line-Associated Bloodstream Infections and Costs. Journal of the Association for Vascular Access: Summer 2019, Vol. 24, No. 2, pp. 11-19.
Background: Central venous catheters are necessary for infusion therapy and often used for blood sampling. Dressings are used to protect the skin and the catheter; however, the pediatric population presents a special challenge because of catheter size, location, and fragile skin.
Methods: A quality improvement project was initiated to minimize frequent or unplanned dressing changes for pediatric catheters. Lean methodology was employed in order to decrease waste within the dressing inventory and maximize value. An interdisciplinary committee was formed to create an evidence-based dressing inventory list, and data were collected before and after implementing the new inventory to ensure that the quality of care was maintained.
-Results: Comparing the preimplementation and post-implementation periods, the types of dressings used were reduced from 10 to 4 types (each type in 1 to 3 sizes). We also recorded a significant reduction in central line-associated bloodstream infections (CLABSIs) post-implementation from a rate of 2.12 to 1.40 per 1000 central line days (P = 0.0297). The number of dressings (units) used decreased after the implementation, while the average monthly cost associated with products dropped from $12,684.83 to $4848.95 (P = 0.0037).
Conclusions: We successfully simplified and standardized our dressing inventory for pediatric central venous catheters without compromising the quality of care. The project led to a decrease in infections and number of dressing changes and to substantial cost savings. Education and training was key in the success of this initiative.