Qualitative analysis of central and midline care in the medical/surgical setting

Community hospital medical-surgical nurses have a limited understanding of the complexities of preventing central line-associated bloodstream infections (CLABSIs). The purpose of this study was to look at the phenomenon of central line care from a human perspective and to develop an understanding of the lived experience as it relates to nursing care.

A qualitative, phenomenology framework was applied for this study.

The study was performed at a seasonally fluctuating, 400- to 600-bed community hospital in southwest Florida.

Fifteen full-time medical-surgical bedside registered nurses, 8 working the 12-hour day shift and 7 working the 12-hour night shift, were interviewed.

Experiences from recorded, 45-minute, in-depth telephone interviews from nurses assigned to 4 medical-surgical units, with the greatest CLABSI frequency, were analyzed.

Findings identified myriad challenges when it comes to administering proper technique and preventing CLABSIs. The themes, time and locus of responsibility, patient population and unit, and variations in experience with CLABSIs, are illuminated.

Nurses have strong feelings and suggestions for organizations to consider in reducing infection rates. Line care education should focus on the relationship of the nurse to understanding CLABSIs, education on line care, supplies, and charting/documentation.

The revealed nature and meaning of the human experience of the central line dressing change and skill actions, identified by the nurses, were brought to the CLABSI committee, and a plan was formed. Six months after implementation of the plan, based on the nurses' lived experiences, the rate of infections has dropped 64%.