Inspired by special training, BMT nurses lead the way in reducing infection rates

After attending a blood and marrow transplant (BMT) conference in Salt Lake City, Utah, a group of University of Iowa Health Care nurses dramatically changed the way they work. The result was a significant reduction in infection rates, a positive impact on central line stewardship culture, and a big boost in team collaboration. The team was recently awarded a Silver Beacon Award for its commitment to quality care.

The idea was to create a two-person central line dressing change team. The team is made up of a core group of “super-users,” nurses who have received extra training for dressing and care for central intravenous lines. The goal was to decrease the number of central line-associated bloodstream infections (CLABSI).

“With our patients’ immune systems already low, keeping out infection is especially important in our unit,” says Shannon Hunger, MSN, RN, one of the conference attendees and nurse manager of the BMT team.

Implementing the idea

Before the BMT team members could begin this new practice, they consulted with several interdisciplinary resources and quality and safety experts, including Mary Beth Kukla, RN, BSN, CIC, infection preventionist; Mary Beth Hovda Davis, MSN, RN, VA-BC, nursing practice leader; and Tacia Bullard, MSN, RN, CNL, nursing practice leader.

They reviewed the research with help from librarians at the University of Iowa Hardin Library for the Health Sciences and collected information on best practices from peers they connected with at the conference.

They landed on a streamlined plan that included standardized processes and supplies and devoted time for the super-users to focus on the procedure as a team. Dressings would be changed on a specific day of the week—Tuesdays. Teams of two were entirely dedicated to their task, which meant that the rest of the nursing team had to work together to ensure other tasks were done.

“We know that nurses are constantly interrupted as they go about their jobs each day,” Bullard says. “That’s why we really wanted to make sure that these super-users had the support to focus solely on central line dressing changes.”

Hunger says the adjustment required a leap of faith.

“It wasn’t easy to make this change” she says. “But once we got going, we started to get into a flow and began seeing some pretty dramatic improvements.”

Bringing UI Health Care’s ICARE values to life

After the initial culture change, the BMT team saw outstanding results. A group with some of the highest risk of developing CLABSI and that historically contributed the largest proportion of the hospital’s CLABSIs now has a much lower than expected rate of infections. On top of that, Hunger says, the team’s effort empowered patients.

“Our patients started realizing that when two nurses entered a room to do this one task that it was a pretty big deal,” Hunger says. “Patients now pay far more attention to these dressings and are our vigilant partners in caring for that central line.”

Now the group is sharing its experience with others throughout UI Hospitals & Clinics.

“What we initially thought was impossible turned out to be absolutely achievable,” Hunger says. “It involves every aspect of the ICARE values: innovation, collaboration, accountability, respect, and excellence.”

An institutional goal to reduce CLABSI has been established, and a cross-discipline team formed. From this, Hunger and her team, along with others, are sharing their process with other high-risk CLABSI groups. The goal is to improve quality care by creating an environment that empowers everyone to make improvements every day.

“At the end of the day, we all want the same thing: to provide excellent care to our patients,” Hunger says. “And by working hard as a team and continuously learning, there are so many rewarding moments along the way.”