Defense Date

3-23-2023

Graduation Date

Spring 5-5-2023

Availability

One-year Embargo

Submission Type

dissertation

Degree Name

PhD

Department

Nursing

School

School of Nursing

Committee Chair

Karen Jakub

Committee Member

Jessica Devido

Committee Member

Leo Yurek

Keywords

Central Line Associated Bloodstream Infections, CLABSI, ICU Nurses, CDC Central Line Bundle

Abstract

Background: Central line associated bloodstream infections (CLABSIs) are one of the most common healthcare associated infections and result in prolonged hospital stays, significant morbidity, and increased costs to the healthcare system. Adherence to the CDC central line maintenance bundle has been shown to be effective in decreasing CLABSI yet these infections continue to be a problem. ICU nurses play a vital role in managing central lines and adhering to the maintenance guidelines, however different situations may arise during the care that may impact CLABSIs.

Objectives: 1) To determine nurses’ adherence to the CDC’s maintenance central line

bundle; 2) To determine if nurses are utilizing additional strategies when managing central lines vis-à-vis positive deviant behaviors; and 3) To explore nurses’ beliefs, motivations, and perceptions related to non-adherence and the utilization of additional strategies.

Methods: Data for this study were obtained from semi-structured interviews and transcripts were analyzed with an interpretive description approach to generate conceptual themes. Interpretation included a focus on the concept of positive deviance to identify additional strategies.

Results: Twenty-seven participants were interviewed from across the United States. The following themes emerged: (a) surmountable barriers, (b) multidisciplinary collaborative impact, and (c) positive deviant behaviors.

Conclusion: This study provides a qualitative assessment of the challenges experienced and the innovative strategies employed by ICU nurses while adhering to the CDC central line maintenance bundle, optimizing patient care quality and preventing CLABSI. Examining the positively deviant behaviors nurses are using may provide the opportunity to improve practices and decrease CLABSI rates.

Language

English

Additional Citations

Burke C, Jakub K, Kellar I. Adherence to the central line bundle in intensive care: An

Integrative Review. Am J Infect Control. 2021;49(7):937-956.

doi:10.1016/j.ajic.2020.11.014

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