Organization: Frederick Memorial Hospital. Solution Title: We Found the Missing Piece to Our CLABSI Puzzle

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1 Organization: Frederick Memorial Hospital Solution Title: We Found the Missing Piece to Our CLABSI Puzzle Program/Project Description: Hospitalized patients are at risk every day for contracting infections. Implementing evidence based practice and new technology can be the right combination to keep our patients safe. CLABSI s continue to be a concern for patients and a financial constraint for the hospitals. Providing bundles for staff to implement is easy, but achieving and sustaining compliance with the bundle is sometimes difficult. Change is hard for everyone, but when our patient s lives are at stake, change is necessary. Healthcare workers want to do the right thing for their patients. They need guidance and evidence that what they are doing will make a difference. Providing education, using audit tools, creating quality-based competitions and providing real time information and data from Infection Control Practitioners made the difference for Frederick Memorial Hospital. Initiating the use of alcohol impregnated caps for all patients vascular access proved to not only decrease CLABSI rates to zero, but also decreased our MRSA bacteremia cases as well. The project started with education and daily audits by our vascular access team. Soon the managers and clinical nurse specialist held staff accountable during daily rounds. Unit data was publicized for all units to see. The competition began. Patient family centered care is the model of care used at FMH and so we included the patients and families in the change and improvement process. Patients were educated to ask for the green caps to be placed on their IV s if the staff forgot them. We advertised the use of the caps in every patient room and hospital elevators. The caps were made easily available for use. Once compliance for using the caps was established and our infection rates decreased, we were able to decrease the amount of audits to quarterly. The decrease in infections was a cost savings to the hospital even after factoring the cost of the caps. Goals: 1. Educate staff on the impact that CLABSI and MRSA Bacteremia s have on patients and hospital resources. 2. Implement a process to decrease CLABSI and MRSA Bacteremia s throughout the organization by using alcohol impregnated caps on all vascular access ports. What was the problem to be solved? FMH patients continued to acquire CLABSI infections with current preventative bundles in place. How was it identified? Patient s positive blood cultures prompted an investigation into nurse s clinical practice. It was found that nurses were not taking the time to clean access ports according to standard length of time. What baseline data existed? FMH CLABSI rates prior to July What were the goals: All central line and peripheral IV line ports/ connectors would be protected by an alcohol impregnated cap (Curos). How would you know if you were successful? Audits were performed to monitor compliance of cap usage. Once compliance reached 85% CLABSI rates began to decrease.

2 FOCUS PDCA was the methodology used to develop the solution. F Find a process The use of alcohol wipes to disinfect IV catheter hubs against bacteria has shown no decrease in blood stream infections. O Organize To Improve the Process Vascular Access introduced an alcohol impregnated cap that could be placed on all IV ports and the ends of IV tubing. C U Clarify Current Knowledge of the Process Understand Sources of Process Variation Prior to implementation, nurses were instructed to scrub the hub of the port with an alcohol wipe for 15 seconds before accessing. Time restraints, lack of readily available supplies and knowledge deficit were factors which affected this practice. S Select The Process Improvement Through evaluation of vendors, a new product was chosen and an educational process was established. P Plan The Improvement Curos was chosen. Green means clean. In-servicing was completed on all units/shifts regarding proper use of the Curos. D Do The Improvement Vendors and VAS assisted with the role out of the cap through education. Caps/tips were stocked on all PAR- E carts. Caps/tips are designed with hangers to hang on patient s IV poles for ease and accessibility of use. Auditing of usage began at implementation so reinforcement training could be done. VAS audited cap/tip usage. C Check The Results Charting and sharing the data of compliance and infections with all stake holders. A Act to Hold the Gain and Continue to Improve the Process Weekly and monthly auditing of usage, as well as blood stream infection rates have been tracked. Ongoing education through one-on-one in-servicing and nursing orientation have proven to be effective for compliance. What Solution was developed? Work with vendor and FMH materials management to purchase alcohol impregnated caps. Then Implementation of the caps was initiated. How was it implemented? Policy changes were made, education of staff members was completed and finally, audits were performed for compliance.

3 Measurable Outcomes: What are the results of implementing the Solution? Provide qualitative and/or quantitative results to data. (Please include graphs, charts, or tools). 100 Compliance of CAPS Usage 80 Percentage May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr May

4 NHSN Defined MRSA Bacteremia, CY Sustainability: Quarterly audits will be performed to ensure that the caps are being used. FMH will provide poster presentations and publications on our results. Role of Collaboration and Leadership: Teamwork was essential for proper implementation of this new initiative across the hospital. It was a change for our supply department who had to find room on all supply carts for the new caps. All areas had to participate including radiology, ED, OR etc. Collaboration and buy in for the use of this product and consistent compliance is what made the project successful. The organization s leadership respectfully challenged the new product for fiscal reasons. The price for the caps was around $50,000 a year. They asked important questions what was the ROI? Knowing that a blood stream infection cost between $20, $50, 0000, if we had only two less CLABSI the product would pay for itself. Thorough investigation and the evidence provided by research and nurses explanations, leadership became engaged and provided the resources to purchase the caps.

5 What partners and participants were involved? Vascular Access Manager Vascular Access Nursing Team Infection Control Team Nursing Quality Council Curos Vendor Value Analysis Committee Staff nurses FMH leadership Innovation: Nurses are faced everyday with more to document, sicker patients and limited time and resources. The invention of the alcohol impregnated caps provides nurses with a clean, bacteria free port to access IV s and give medications without having to scrub the hub and worry about contamination. What are its unique attributes? The alcohol impregnated cap kills bacteria after 3 minutes once it is placed and keeps the port clean for 7 days when left on. Related Tools and Resources The Solutions selected to receive the Minogue Award for Patient Safety Innovation will reflect the following Award criteria: Be innovative Demonstrate measurable change Exhibit strong collaboration Exhibit strong leadership Advance the culture of patient safety Constitute a best practice with the ability to spread