Date of Conferral

2022

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Melissa Rouse

Abstract

Abstract Hemodialysis is a life-sustaining procedure for patients diagnosed with end-stage renal failure. Most of these patients initiate hemodialysis with a tunneled central venous catheter, with some depending on its use for long-term treatment due to poor vascularity. Catheter-related bloodstream infections in hemodialysis patients are a complication of hemodialysis catheter use with a high morbidity and mortality rate. A quality improvement (QI) project was conducted to answer the practice-focused question of whether the use of chlorhexidine swabs and caps for central venous catheter dressing changes decreased the rate of hemodialysis catheter-related bloodstream infections. Resolution to this problem would benefit the patient, the state-funded Medicare and Medicaid Services, and the hemodialysis facility. A retrospective analysis using Lewin’s change theory was used to conduct the QI evaluation project. Three months of pre- and post chlorhexidine intervention data were analyzed. The analyzed data from 70 patients were obtained from the hemodialysis facility’s infection control department and included a comparison to the standardized infection ratio. Three months prior to the implementation of chlorhexidine there were five infections, and three months post implementation of the chlorhexidine there was only one. The recommendation based on the evaluation findings is that a protocol including guidelines for chlorhexidine use be established, followed by the implementation of annual staff competencies. This will impact positive social change by decreasing the rate of hemodialysis catheter-related bloodstream infections and subsequent morbidity and mortality at this hemodialysis facility and can also be used at other facilities.

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