Bundle Me Up! Using Central Line Bundles to Decrease Infection

Transcription

1 Bundle Me Up! Using Central Line Bundles to Decrease Infection Organization Name: Peninsula Regional : Acute Care Hospital Medical Center Contact Person: Regina Kundell Title: Dir, Women s and Children s Services regina.kundell@peninsula.org Phone: IDENTIFICATION: Central line associated blood stream infections () are a major source of neonatal mortality and morbidity, as well as a financial burden on families and health care facilities. In fact, a single central line blood stream infection can increase the hospital length of stay by 7-21 days and can cost $3,700 to $29,000 to treat. The Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI) and the National Healthcare Safety Network (NHSN) recommend best practice bundles as a method to reduce s and their sequelae. The problem was identified at our facility through networking with the Perinatal Collaborative and the Neonatal Collaborative and our Infection Preventionist. Baseline data included a very low rate infections for our neonatal population, but some room for improvement through the adoption of best practice guidelines and bundles. PROCESS: The methodology included adopting the best practice bundles for central line insertion and maintenance including briefing prior to the procedure and debriefing post-procedure. The process included networking, benchmarking, literature reviews and rewriting policy and procedure to include best-practice guidelines for Neonatal Central Line insertion and management. The action plan was developed for initiation, staff education, implementation and feedback through collaboration with leadership, staff and physicians. Project components to be initiated: Central Line Insertion Bundle Using Briefing/Debriefing checklists Maximum sterile barrier precautions utilized Skin disinfected (CHG, Povidone Iodine) Dedicated team for placement & maintenance Dedicated cart containing all needed supplies Excellent hand hygiene

2 Insertion checklist Optimal timing of insertion Time-out & Stop the Line Central Line Maintenance Bundle Daily assessment of need for line Reduce lipid days Daily review of dressing integrity & site cleanliness Closed system for infusion, blood draws & medication Clean or sterile technique for infusion tubing assembly & connection Scrub injection port using friction for at least 15 seconds prior to entry Use prefilled flush containing syringes Clean gloves for all VAD entries & excellent hand hygiene SOLUTION: We began this project with briefing and debriefing checklists and re-enforcing our existing Universal Time-Out procedure. These new documents and the time-out review were discussed at our bi-monthly divisional meeting and then disseminated to front-line staff, including physicians and respiratory therapists. Our annual skills day coincided nicely with the initiation of the process, so everyone received the same information. Our educational day included a simulation scenario with briefing/debriefing, a lively Jeopardy game and documentation review. The second stage of our process included a unit bulletin board with the Central Line Bundle components highlighted. This provided staff with a reminder and a quick checklist whenever a central line was to be placed. A dedicated Central Line cart with necessary supplies and checklists was included in the process implementation. The third stage of our process has been monitoring our progress through entry into the IHI website database. Our current data shows ZERO central line infections for 2009, 100% compliance with the Central Line Insertion Bundle and a 100% compliance with the Central Line Maintenance Bundle. Our initial compliance scores were related to documentation issues rather than practice issues surrounding appropriate care of the line. Once our documentation format was fixed, and our compliance improved in the last quarter of We are dedicated to improve and sustain our results over time by celebrating our successes, sharing our results in-house via poster presentations and continuing to do chart reviews and continuing education.

3 OUTCOMES: Central Line Insertion Bundle Compliance The number of infants with central lines that receive all aspects of the central line insertion bundle. Insertion bundle includes: Hand hygiene; Use of semi-permeable dressings when possible; Use gauze only with bleeding/oozing for central line (umbilical catheters are excluded); Use of maximum barrier precautions (sterile technique maintained throughout); Prepare skin with antiseptic. Time Period Value Total Number of Infants with Compliant Insertion Bundle Total Number of Insertions Observed None None None None - Central Line Maintenance Bundle Compliance The percentage of infants with central lines that are compliant with all aspects of the central line maintenance bundle. Maintenance bundle includes: Hand hygiene; Aseptic technique maintained throughout all aspects of care (i.e. dressing change, catheter entry, infusion tubing change); Use transparent semi-permeable dressings when possible/use gauze only with bleeding/oozing for central lines (umbilical catheters are excluded); Replace dressing if it becomes damp, loosened or visibly soiled; Prepare skin with antiseptic when performing dressing change. Time Period Value Total Number Infants Compliant with Maintenance Bundle Total Number of Maintenance Events Observed None None None None None -

4 Rate Per Month (751-1,000g) The rate of infections for 751-1,000g per thousand line days. (751-1,000g) between 751-1,000g None None None - Rate Per Month (1,001-1,500g) The rate of infections for 1,001-1,500g per thousand line days. (1,001-1,500g) between 1,001-1,500g None None None -

5 Rate Per Month (1,501-2,500g) The rate of infections for 1,501-2,500g per thousand line days. (1,501-2,500g) between 1,501-2,500g None None None - Rate Per Month (>2,500g) The rate of infections for >2,500g per thousand line days. (>2,500g) >2,500g None None None None None None -