There doesn't seem to be any updated discussions regarding the use and application thereof a central line maintenance bundle. I can come up with our own hospital standard of care for maintenance components: tubing labeling
scrubbing the hub
dressing changes
daily line necessity
hand hygiene
changing needleless connectors
but I'm wondering how those that are using a maintenance bundle actually observe compliance. We have a vascular access team that assesses every central line everyday but recording data collection is time we don't have. Our infection preventionists is saying just have a list next to the bed that the staff nurse can check the components as a reminder, but this is more informational not true compliance data.
Just looking for advice as to how others are using a maintenance bundle and capturing compliance.
One of my videoconference presentations earlier this year was about looking at the evidence for maintenance bundles for VADs. There is no consensus from studies as to what should be included in these bundles, no recommendations from any organization about their contents. You brought up a good point about surveillance. An insertion procedure is one episode of care that requires an assistant anyway. This assistant is the one to observe the techniques used and complete this checklist. The new SHEA Compendium chapter on CLABSI states that this insertion checklist should be completed by someone other than the inserter. Routine nursing care happens throughout the shift and no one is there to observe. So you can only rely upon self-reporting for what was or was not done. Self reported data is the least accurate. It comes down to what you want to do with this data. You could have the checklist in each room as a simple reminder to each nurse about what is to be done. You could have patient education pieces so they can monitor what is or is not being done. You could do point prevalence studies to observe what is being done, but when observed human nature dictates we follow the rules but that might not be the case when no one is watching. I don't think we can rely upon maintance checklist to improve the situation. We can educate, monitor outcomes, and provide additional education, or performance improvement initiatives when outcomes are not good. But to rely upon the accuracy of self reported data for details of compliance is not that effective, in my opinion. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861