Central line dressing changes

[Chieif20]

I am currently looking for some evidence based practice to see what other hospitals do to ensure staff are really doing the central line dressing changes STERILE. Of course we dont want to hover at the bedside and watch every nurse but we do want to bring down our BSI rates. We are currently tracking specific patients and starting with educating particular nurses that may have cared for the patient. So my question to all of you is what measures does your hospital take? Thanks!

[WSU_Ally_RN, BSN, RN]

We use clean gloves to remove the old dressing. Put on a face mask, sterile gloves, and use a sterile dressing change kit with chlorhexadine scrub. Scrub for 30 sec, let dry for 30 sec (without blowing or fanning the site) then place an occlusive opsite dressing. Our unit has really low rates of CLABSI with our policy. We change dressings q7 days, or whenever it is not occlusive, soiled, wet, or bloody.

[tyvin, BSN, RN]

I know I'm out of line here but why spend money to see if your employees are honest? Don't they think RNs practice in the scope they are required? Do they really think RNs cheat to save time with doing clean vs sterile? Or is it perhaps they don't know any better and we need these types of studies to oversee licensed RNs? Seriously ...

I think you know what I think about this.

[ckh23, BSN, RN]

Dressing and end caps are changed q 7 days or prn if soiled. We change the dressing using sterile technique and we have central line dressing kits we use. The kits also come with end caps so they are replaced at the same time. Chlorahexedine scrub is used as the antiseptic and the insertion site is covered by a chlorahexedine dressing. We have no protocol in place that would "ensure" sterile technique. I thought that was part of being a professional.

Central line dressing changes are also tested during our yearly competency to ensure nurses know and use sterile technique during the dressing change.

If you think the nurses are the problem, are you able to connect patients with CRBSI to when and what nurses are doing the dressing changes?

Another source could also be how the central line is being accessed. Are the nurses "scrubbing the hub" for the proper amount of time?

[Chieif20]

Sorry,

This has nothing to do with being "professional", or honest. Or even trying to hold nurses soley liable. Yes, our facility does use the central line dressing kits which contain the chlorhexadine wands, a mask, biopatch, and trasparant dressing. We practice scrubbing hub, and use alcohol swabs on the hub prior to accessing the ports. We change dressings every 3 days, and tubing every 4 days. thanks for your inputs.

[craziechiq, BSN, RN]

You change the central line drsg q3days? I have only been to hospitals where it was policy to change q7days unless soiled, bloody, etc... Could changing it so often have something to do with it? That could put them at higher risk for infection. I don't know, just my 2 cents.

[pinkkitty11]

Well there's your problem. Every time the dressing is changed, you are exposing the insertion site. I do one of these changes approximately every shift.. At my hospital we change every 7 days and as needed if soiled. I also make sure I have 2 pairs of sterile gloves, one to change the dressing and the other to change the caps. I also change all of the tubing.

[Double-Helix, BSN, RN]

First, any time the central line is accessed we scrub the port with Clorahexidine 2% for 30 seconds and let it dry for 30. Any time the central line is opened (cap changes, line changes) it's sterile technique- gloves and mask.

When the dressing is changed, it's clean technique to remove the dressing. Everyone at the bedside, including the patient, wears a mask. After the dressing is removed, it's sterile gloves and sterile technque. The area is scrubbed with Clorahexidine for 30 seconds, and for a femoral line it's a 2 minute scrub, and air dries. Absolutely no blowing on the site or fanning it to dry it. Then the sterile bio-occlusive dressing is applied. We do not use any adhesives under the dressing. Standard dressings are changed weekly and PRN. If a dressing has gauze under the bio-occulsive it's changed in two days.

We have an extremely low rate of infection. I think we have had one infection in the past 2.5 years.

[klone, MSN, RN]

What is CLABSI and CRBSI?

[WSU_Ally_RN, BSN, RN]

CLABSI= Central Line Associated Blood Stream Infection... not sure about the other one

[msjellybean]

You change the central line drsg q3days? I have only been to hospitals where it was policy to change q7days unless soiled, bloody, etc... Could changing it so often have something to do with it? That could put them at higher risk for infection. I don't know, just my 2 cents.

At my facility, central line dressing changes are every 7 days, unless the person is neutropenic, in which case it's every 3 days. This has always seemed so counter-intuitive to me! They're at a greater risk for infection, so let's open up a system that's very easy to get infected on a more frequent basis.

[ckh23, BSN, RN]

What is CLABSI and CRBSI?

Catheter Related Blood Stream Infection