Describe the impact of CLABSI on patients and their families. Discuss three methods of reducing CLABSIs Explore the essential elements of maintaining decreased CLABSIs 1
2001-43,000 CLABSIs In ICUs 2009-18,000 CLABSIs In ICUs resulting in a 58% reduction 23, 000 CLABSIs now occur outside of the ICU setting They account for about 12.3% fatality rate They increase hospital stays by as much as three weeks Cost for one infection ranges from $3,700 $36,441 Per the CDC an average infection costs $16, 550 www.jointcommission.org/assets/1/18/clabsi_monograph.pdf www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf 2
Increased length of stay Use of increasingly potent antibiotics Sepsis Transfer to a higher level of care ICU Death Cap Stone project for Master s degree. Goal - to look into creating a vascular access team that would insert all IVs and PICCs. Evidence based PICC nurses - also part of the resource team and were assigned to a team of patients. Not a formal team with set expectations. Nurses had to leave what they were doing to go start a line that often took more than an hour. 3
The Michigan Keystone project IHI Save 5 Million Lives campaign with initiative to decrease central line associated blood stream infections. Center for Disease control The Joint Commission and National Patient Safety Goals Infusion Nurses Society, Oncology Nurses Society APIC, SHEA PICC team became an official team 1. Did not take patients 2. Responsible for rounding on all PICCs in the hospital 3. Changed dressings that were due to be changed. Acted as a resource for staff RNs 4
November 2008 - Product change from positive pressure access device to a split septum access device. Hand hygiene Use of sterile gloves Maximum barrier insertion technique Use of chlorhexidine skin prep Avoiding the femoral area for access Evaluating the ongoing necessity of the line 5
2009 - Board of Directors became involved in safety measures at our hospital. Participated in the 2 year On The CUSP Now had an executive champion The Chief Nursing Executive Check list for central line insertion Set the stage for nursing to be advocates for patients. Listed steps that were standard procedure for insertion of a central line. WIGs are Wildly Important Goals. The team met once a week for 20 minutes. All assignments were expected to be completed by the next week or an update given. 6
Chief Nursing Executive Infection Control Specialist Nursing manager for the Surgical Unit Nursing manager for the PICC RNs Oncology staff RN Nursing Educator Materials management specialist Cath Lab manager from sister hospital 7
Put into policy scrubbing access hubs for 15-30 seconds each and every time the catheter is accessed. Gloves are to be worn anytime the catheter is accessed. Blood draws from a central Line are prohibited unless there is a physician order to draw from line That ll never happen! I know what they taught you but here we do it differently. This is the real world of Nursing. OR We are in a sterile environment. We don t need to scrub each and every time 8
Rub a Dub - Dub Give the Hub a Scrub 1. Wash hands before touching central lines 2. Apply clean gloves for possible exposure to blood or if disconnecting IV tubing 3. Give the hub a scrub for 15-30 seconds Prior to each access. 4. Wash hands or use antiseptic gel before leaving the room. Creation of a Code C Every CLABSI is reviewed for areas that can be improved. Intensive education on proper techniques for caring for central lines Creation of a Scrub the Hub video starring employees from across the hospital system 9
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October 2008 September 2009 21 CLABSIs October 2009 August 2010 11 CLABSIs Zero CLABSI in the Medical ICU since April of 2009 Zero CLABSI in the Surgical ICU since August of 2010 Throughout the hospital CLABSI rates have decrease by 45% 2009 19 incidents 2010 10 incidents No more than 2 per month 2011 YTD (January April) 2 incidents 2012 YTD 3 incidents 2 on Oncology, 1 on surgical unit Active involvement of an Executive Champion Don t Blink PICC nurses round on all PICC lines in house daily Everyone must be accountable Get on board 12
Berenholtz SM, Pronovost PJ, Lipset PA, et al. Eliminating catheter-related bloodstream infection in the intensive care unit. Critical Care Medicine. 2004;32:2014-2020. Cook, G. AVA 2008 O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. Aug 9 2002;51(RR-10):1-29. www.cdc.gov/mmwr/pdf/rr/rr5110.pdf Richardson, JAVA, Spring 2008 Soufir L, Timsit JF, Mahe C, Carlet J, Regnier B, Chevret S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infect Control Hosp Epidemiol. 1999;20(6):396-401. www.nejm.org/doi/full/10.1056/nejmoa061115 The Joint Commission. Preventing Central Line Associated Bloodstream Infections: A Global Challenge, a Global Perspective. Oak Brook, IL: Joint Commission Resources, May 2012. http://www.preventingclabsis.pdf. www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf 13