Lisa Waugh, R.N. C.D.N. Jaitha Kalladanthyll R.N. C.D.N., Pat Bork, R.N.
Learning Objectives ◦ To review new CDC guidelines relative to hemodialysis catheters ◦ To describe a practice change project to comply with current evidence based practice for hemodialysis catheters
Acute Dialysis Unit ◦ 410 bed community hospital ◦ 8 bed in-patient unit ◦ Approximately 50 patients per month ◦ 2400+ treatments per year Nursing Practice ◦ American Nephrology Nurses Association Standards of Practice ◦ CDC guidelines
Infections are one of the leading causes of hospitalization and death for patients on Hemodialysis >20% of dialysis patients have central lines 37,000 access- related BSI’s yearly. (CDC, 2008) 25% of CLABSIs in 2011 were in HD catheter patients at SJH The purpose of this project is to fully comply with CDC recommendations and reduce CLABSI in our dialysis patients.
CLABSI rates at SJH include: Patients with Hemodialysis Catheters which 1. may also have other central lines. Overall rates determined by 2. #infections/1000 device days CLABSI rate identified specifically for 3. Patients with Dialysis Catheters
Year TOTAL L CLABS BSI in % CLABS BSI with Overall CLABS BSI patients ts HD (Rate) CLABS BSI with th HD* Rate 2009 25 5 20% (3.47) 1.07 2010 6 1 17% (0.42) 0.25 2011 16 4** 25% (1.41) 0.82 2012 4 0 0% (0.00) 0.56 (January – May) *9/10 patients with HD also have CL **Last HD CLABSI in September 2011 Rate is per 1,000 device days
Total Devi vice Days 2009 2009-2012 25000 23604 23267 19409 20000 2009 CL 2009 HD 15000 2010 CL 2010 HD 10000 2011 CL 5744 2011 HD 5000 2836 2592 2012 CL 2377 914 2012 HD 0 CL HD CL HD CL HD CL HD 2009 2010 2011 2012
Hand hygiene Maximum Barrier Precautions Chlorhexidine Skin Prep Sterile Technique April 2011 Added Recommendation of Antibiotic Ointment for HD Catheters Added Recommendation to Assess Staff for Adherence to Guidelines Need to change practice
Chose catheter compatible ointment Partnered with IV Team and Pharmacy Physician Approval and Policy Change Change implemented September 2011 Audited Staff for Adherence OUTCOMES ◦ No CLABSI in patients with HD catheter since practice change ◦ Staff 100% compliant
Infection Rates Post Practice Change 1.6 1.4 Infections per 1000 Device Days 1.2 1 0.8 0.6 0.4 0.2 0 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 CLABSI Rate 1.11 0 0.58 0.59 0 0.82 1.48 HD Rate 0 0 0 0 0 0 0
Follow CDC guidelines which includes: Hand hygiene I. Maximum Barrier Precautions II. Chlorhexidine Skin Prep III. Antimicrobial ointment at insertion site with IV. each dressing change Periodic Assessment of Staff for Adherence V. to Guidelines
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