From Chaos to Consensus: A Collaborative Approach To Standardize the Placement of Central Lines

ISSUE: Central line-associated bloodstream infections (CL-BSI) lead to significant mortality and are estimated to cost at least $25,000 per incident. Proper skin antisepsis and insertion technique are important steps to prevent these infections. At the University of Kansas Hospital, a 454-bed academic medical center, central lines are inserted by residents and attending physicians in many settings. Although CL-BSI rates were below NNIS mean rates, observations by Infection Control found significant variations in central line insertion practices. Infection Control and IV Therapy used a team approach to develop consensus standards based on 2002 HICPAC Guidelines for the Prevention of Intravascular Catheter-Related Infections. PROJECT: A committee was formed, with physician and nursing representatives from each setting in which central lines were inserted. Meetings were held over a 4-month period to review the HICPAC guidelines. Discussions were often heated, as different opinions were voiced. When questions arose, we reviewed studies cited by HICPAC to ensure a science-based approach. New products were selected to support the recommendations. RESULTS: Written consensus standards, based on HICPAC guidelines, are now followed each time a central line is inserted. LESSONS LEARNED: This initiative was successful because important stakeholders were involved in the decision-making process. Although it was difficult for each committee member to attend every meeting, email proved to be an effective way to share information and opinions. Basing decisions on a review of the literature brought credibility to the process and eliminated personal bias.