Lisa Waugh, R.N. C.D.N. Jaitha Kalladanthyll R.N. C.D.N., Pat Bork, - - PowerPoint PPT Presentation

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Aug 19, 2022 254 likes •401 views

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

SLIDE 1

Lisa Waugh, R.N. C.D.N. Jaitha Kalladanthyll R.N. C.D.N., Pat Bork, R.N.

SLIDE 2

 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

SLIDE 3

 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
f Practice
CDC guidelines

SLIDE 4

 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.

SLIDE 5

 CLABSI rates at SJH include: 1.

Patients with Hemodialysis Catheters which may also have other central lines.

2.

Overall rates determined by #infections/1000 device days

3.

CLABSI rate identified specifically for Patients with Dialysis Catheters

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Year TOTAL L CLABS BSI CLABS BSI in patients ts with th HD* % CLABS BSI with HD (Rate) Overall CLABS BSI 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 (January – May) 4 0% (0.00) 0.56

*9/10 patients with HD also have CL **Last HD CLABSI in September 2011 Rate is per 1,000 device days

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23267 2592 23604 2377 19409 2836 5744 914

5000 10000 15000 20000 25000

CL HD CL HD CL HD CL HD 2009 2010 2011 2012

Total Devi vice Days 2009 2009-2012

2009 CL 2009 HD 2010 CL 2010 HD 2011 CL 2011 HD 2012 CL 2012 HD

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 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

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 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

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0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12

Infections per 1000 Device Days Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 CLABSI Rate 1.11 0.58 0.59 0.82 1.48 HD Rate

Infection Rates Post Practice Change