Compliance in the Reduction of Central Line Bloodstream Infections - - PowerPoint PPT Presentation

Real Time Observation of Central Line Care and Maintenance Bundle Compliance in the Reduction of Central Line Bloodstream Infections

Gina Garrett, BSN, RN, CRNI, VA-BC Kim Lucas, RN, CCRN Kristie Koch, BS Susan Cali, MSN, RN, MHA Emory University Hospital Midtown

Purpose

Standardize and align nursing practice with evidence based guidelines to reduce central line bloodstream infections at Emory University Hospital Midtown

Aim

Reduction of Central Line Bloodstream Infections

Background

• EUHM CLABSI were above NHSN mean
• CLABSI are now reported to CMS via NHSN
• Nursing practice for care of central lines varied

throughout the hospital

• Pay for Performance Initiative by CMS
• Cost $16,550 to $45,000 estimated per

CLABSI

• TJC patient safety

Baseline Data

• There had been 68 CLABSI from September

2012 through March 2011

• Compliance rate for care and Maintenance

bundle was 56.6% in April of 2011

• Poor compliance with all bundle components
• Initial bundle contained 12 components

Practice Change

• Reviewed Evidenced Based Guidelines
• Reduced number of components of Care and

Maintenance Bundle from 12 to 5 to better fit staff work flow

• PDSA Cycle
• Developed electronic data tool

– Sixteen observations per month

Care and Maintenance Bundle

• 1. Central line dressing dated
• 2. Central line dressing changed in last 7 days
• 3. Transparent dressing
• 4. IV tubing dated
• 5. Biopatch present and placed correctly

Central Line Care and Maintenance Bundle

Multi-lumen Catheters, PICC, Implanted Ports, Hemodialysis/Apheresis Catheters, Tunneled Catheters

HAND HYGIENE

Before and after all patient contact, use of gloves and manipulation of central lines

DAILY TASK

 Site assessment and documentation  Central Line Necessity/removal of central line if no longer needed  Scrub the Hub with alcohol prior to each access for at least 15 seconds/let dry  Check each catheter lumen for patency and document*  Flush each catheter lumen before and after any infusions or medication administration*

WEEKLY TASK (every seven days)**

 Change central line dressing/needleless connector/securement device  Use Chlorhexidine (CHG) patch on all central lines

IV TUBING AND FLUIDS

Every 12 Hours Change and label Propofol tubing Every 24 Hours Change and label all IV fluid bags Change and label TPN tubing Every 48 Hours Change and label Epidural/PCA tubing Every 96 Hours Change and label primary/secondary tubing

* Patency of Hemodialysis/apheresis catheters should not be established except if the catheter has a 3rd (middle)

• lumen. Patency and flushed per protocol is required for the 3rd (middle) lumen.

* Central line dressing will be changed if not intact (loose), wet, and/or soiled. ** Needleless connectors will be changed with each dressing and PRN visible blood in connector. ** Securement device (if present) will be changed with each dressing.

** CHG patch will be changed with each new dressing and/or if patch becomes 50% saturated.

8/2011 v10 EHC

Results

• Decrease in CLABSI for FY 2012

– 68 CLABSI YTD FY 2011

• Rate 1.04 per 1000 patient days

– 21 CLABSI YTD FY 2012

• Rate 0.33 per 1000 patient days
• Increase in bundle compliance

– Increased compliance to 84.95% with 13 units reporting

• Decrease in bundle components
• Developed root cause analysis process

Challenges/Barriers

• Lack of buy in from nursing leadership and staff
• Multiple competing initiatives
• Observation basis
• Lack of knowledge regarding impact on patients

and organization from nursing leadership and staff

• Developing unit specific processes for data

collection and care of patient’s with central lines

Next Steps

• Focus on issues related to non-compliance
• RCA on every CLABSI
• CLABSI Team Meetings including leadership,

champions and medical staff twice a month

• Feedback of CLABSI rates and audits on unit

level

Questions

?