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Practical Strategies for Addressing CLABSIs: Perspectives from Florida NCABSI Hospitals FHA Hospital Engagement Network Florida Perinatal Quality Collaborative Coaching Call #18 August 19, 2014 Todays Call Welcome by Kim Streit

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Practical Strategies for Addressing CLABSIs: Perspectives from Florida NCABSI Hospitals

FHA Hospital Engagement Network Florida Perinatal Quality Collaborative Coaching Call #18 August 19, 2014

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Today’s Call

  • Welcome by Kim Streit
  • Introduction by Dr. Douglas Hardy
  • Hospital Presentations

– Baptist Hospital – St. Joseph’s Women’s Hospital – Broward Medical Health Center

  • Discussion
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Douglas E. Hardy, MD

  • Clinical Director, Neonatal

Intensive Care Unit, Winnie Palmer Hospital

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Ashley Darcy-Mahoney, Ph.D.

  • Neonatal Nurse Practitioner, South

Dade Neonatology

  • Assistant Professor, Emory

University Nell Hodgson Woodruff School of Nursing

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Our Journey to Zero CLABSI

Camila Takahashi, RN, BSN, RNC Ashley Darcy Mahoney, PhD, NNP Gisela Diaz-Monroig, MD

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Saving Lives by Ceasing Lines

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South Dade Neonatology| Baptist Health

Plan

  • BCH NCABSI Interdisciplinary Team
  • Review action plan with team
  • Introduce to all BCH NICU care providers the initiative

and process for live-audits

  • Delegate data collection and entry methods
  • Review monthly reports and evaluate progress
  • Attend monthly webinars / conference calls

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South Dade Neonatology| Baptist Health

Challenge #1: Baseline Data

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South Dade Neonatology| Baptist Health

Baseline Data: Central Line Days

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Initiation of NCLABSI Project Mean 420

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South Dade Neonatology| Baptist Health

DO

  • Educate staff on project and live auditing tool
  • Re-educate staff on Central Line Bundles (CLB)
  • Daily live audits and data entry in national database
  • f CLB compliance for insertion and maintenance of

all central lines and CLABSI

  • Daily Assessment of necessity of each central line.

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South Dade Neonatology| Baptist Health

Challenge #2: Audit Completion Compliance

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Audit Form Revised

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South Dade Neonatology| Baptist Health

  • Need to change culture across medical team and

nursing team

  • Poor audit completion compliance
  • Forms were being lost/misplaced
  • Reduction in days between CLABSI
  • Audit was bringing awareness

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Study

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COLLABORATION

What changes need to be made? How can we move forward collectively?

Culture Eats Strategy for Breakfast

  • - Peter Drucker
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South Dade Neonatology| Baptist Health

  • Reached out to FPQC NCABSI listserv
  • Adopted and modified Florida Hospital’s audit tool
  • Revised daily audit form

– New form allows for seven days of audits

  • Forms were made accessible

– Folder placed inside each CLB box and at bedside

  • Continue daily audits of every central line
  • Awareness to everyone

– Audits, monthly emails and huddles

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Act

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South Dade Neonatology| Baptist Health

Maintenance Audit Revised

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Insert key fact connected with photo

Insert Photo

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South Dade Neonatology| Baptist Health

Change Theory: Anchor/Refreeze

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South Dade Neonatology| Baptist Health

Challenges & Lessons Learned

■ COLLABORATION: potentially better practices within the project were explored with other involved institutions. ■ EDUCATION: initial and ongoing education increased staff awareness and understanding of safe management of central lines. ■ COMMUNICATION: open communication led to discontinuation of lines in a timely manner, staff feedback on QI and transparency in opportunities for improvement ■ CELEBRATION: highlight successes and reinforce the purpose for the project

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South Dade Neonatology| Baptist Health

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Baptist Children’s Hospital Accomplishments

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South Dade Neonatology| Baptist Health

Challenges Accepted: Results

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South Dade Neonatology| Baptist Health

Challenges Accepted: Results

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Jayne Solomon, ARPN-BC

  • Quality Coordinator, St. Joseph’s Women’s Hospital,

Tampa

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  • St. Joseph’s Women’s Hospital Story –

Who We Are…

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Before you Begin

  • Review your current data‐ Establish a baseline
  • Develop an NICU CLABSI Reduction

Committee

  • Literature Review for best practice measures‐

Adopt a Toolkit

  • Design Method: PDSA Cycle
  • Plan, Do, Study, Act
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Methods and Strategies

Hand Hygiene Campaign and monitoring Central Line Insertion Bundle

1) Hand hygiene 2) Maximum barrier precautions on insertion 3) CHG for Skin Antisepsis 4) Optimal Site Selection

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Methods and Strategies‐ 2010

Central Line Maintenance Bundle

Daily review of line necessity: Prompt removal

  • f PICC line at 120ml / kg

CL Dressing Change Port Set‐up and Access

– Closed IV administration system – “Scrub the Hub” – IV tubing change

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Additional Strategies

  • Additional hand soap and gel dispensers added in

work areas

  • Boxes of gloves easily accessible
  • Use of CHG‐impregnated dressing (Biopatch™)

infants >28 weeks and 10 days of age

  • Use of Claves
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Promote Skills & Education

  • Nursing Education during “Lunch & Learn”

sessions

  • Validation of skills during line draws, tubing

changes

  • Skills Fair (hand hygiene, tubing changes, CL

Care)

  • Random audits (hand hygiene, line changes

and central line insertion)

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Methods and Strategies, 2013‐2014

  • Monitoring of other hospital‐acquired

infections (non‐CL related BSI, VAP, UTI)

  • Parent education related to hand hygiene
  • Bundle of Love (Audit Tool)
  • PICC Team Daily Rounding
  • Intense Reviews
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Challenges

  • Staff Buy‐In
  • Compliance
  • Support from other

departments

  • Competition with other

projects

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Keys to Success

  • A Project Champion is critical. A nurse lead

and a physician lead.

  • Quality Bulletin Board
  • Newsletter‐ What is an HAI?
  • Recognition‐ Parties
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Lessons Learned

  • Staff must understand that CLABSI are preventable
  • The GABBY video available through the Perinatal

Quality Collaborative of North Carolina is excellent.

  • Hand hygiene is the key to CLABI reduction and

hospital acquired infections

  • Audits are critical to sustain results
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Recommended Resources

Corzine, M., & Willett, L, D., (2010). Neonatal PICC: One unit’s six‐year experience with limiting catheter complications. Neonatal Network (29), 161‐173. Ellsbury, D.L., & Spitzer, A.R. (2010). Quality Improvement in Neonatal and Perinatal Medicine (Vol. 37). Elsevier Institute for Health Care Improvement (2008). Implementation the central line bundle. Retrieved November 12, 2009, from http://www.ihi.org/IHI/Topics/CriticalCare/IntensiveCare Semelsberger, C., (2009). Educational interventions to reduce the rate

  • f central catheter‐related bloodstream infections in the NICU: A

review of the research literature. Neonatal Network, 28, 6 p 391‐ 395.

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Broward Health Medical Center

  • Dr. Johny Tryzmel, NICU

Medical Director

  • Maria Osuch, BSN, RNC-NIC
  • Jennifer Bilecki, MSN, ARNP,

RNC-NIC

  • Susan Varughese, BSN, RN
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FANTASTIC FOUR

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Physician Champions:

Dr.Ed.Otero,NICU Dr.PatRowe‐King,Peds

  • Dr. Venue Devabhaktuni, PICU

Dr.Rudolph Roskos,Hem/Onc

THE TEAM

Maria Osuch, NM NICU Carol Bhim, NM Peds Nicole Sant’elia, NM Hem/Onc. Jennifer Bilecki, CS, NICU Sandra McGrath, CS, PICU Serena Toney, CS, Peds Pablo Mora, CS, Epidemiology Robert Tellez, Materiels Bea Reynolds, Quality

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Poor Technique Inconsistent PPE use Non‐Compliance with

procedure Inadequate insertion

technique Maintenance non‐compliance

Lack of available

supplies Staff non‐compliance with

Bundle

Rounds – lack of focus

  • n lines

Tracking –

Compliance issues

Tracking – Compliance issues

Lack of

support/Key

players

Patient/Family

complaint

Dressing size – too small

LOS

Care of Hub Culture Technique Nursing care Care of site

BRAINSTORM: NICU/PICU/PEDS/PED Hem. Onc. Possible Reasons for CLABSI

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ZERO

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NICU

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Calendar year of 2013 NICU rate of 0. Calendar year of 2014 encountered two infections. Performed a thorough review. Back to chasing the 0.

NCABSI PHASE II UPDATE

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Questions?

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Today’s Call

Hospital Engagement Network- Status Presentation by Dr. Douglas Hardy Discussion