Post on 16-Dec-2015
Central Line Associated Central Line Associated Bloodstream Infection Bloodstream Infection
Prevention is Primary!Prevention is Primary!
Tennessee CollaborativeTennessee CollaborativeReducing Healthcare Associated Reducing Healthcare Associated
Infections Infections
Erlanger Health System Erlanger Health System ImplementationImplementation
Erlanger Health SystemErlanger Health System
Level 1 Trauma Level 1 Trauma CenterCenter
4 Inpatient 4 Inpatient Campuses Campuses
564 Inpatient Beds - 564 Inpatient Beds - Adult and PediatricsAdult and Pediatrics– 77 Adult ICUs with Adult ICUs with 6666
beds beds – 5050 bed Neonatal ICU bed Neonatal ICU – 88 bed Pediatric ICU – bed Pediatric ICU –
expanding to 12 bedsexpanding to 12 beds
CLA-BSI Prevention CLA-BSI Prevention “Erlanger Timeline”“Erlanger Timeline”
19991999 Implemented CHG skin prep for CVL insertions Implemented CHG skin prep for CVL insertions and site care and use of antimicrobial impregnated CVL and site care and use of antimicrobial impregnated CVL in TICUin TICU
2000- 20012000- 2001 Implemented use of CHG skin prep and Implemented use of CHG skin prep and antimicrobial impregnated CVL in other ICUsantimicrobial impregnated CVL in other ICUs
20022002 Standardized central line dressing change kit and Standardized central line dressing change kit and site care site care
20032003 Implemented new central line insertion kits to Implemented new central line insertion kits to include all items for the procedure including;include all items for the procedure including;
Full Sheet drape Full Sheet drape Chloraprep™Chloraprep™ Safety devicesSafety devices
CLA-BSI PreventionCLA-BSI Prevention“Erlanger Timeline”“Erlanger Timeline”
20062006 Central Line Central Line checklist implemented checklist implemented
2007 2007 Development of Development of poster to show the poster to show the major points related to major points related to CVL insertion and CVL insertion and placed on all patient placed on all patient care unitscare units
2008-092008-09 Participation Participation in the statewide in the statewide initiative to reduce initiative to reduce healthcare associated healthcare associated infectionsinfections
““Bundle Components”Bundle Components” Hand HygieneHand Hygiene Maximal sterile barriersMaximal sterile barriers CHG skin antisepsis- Chloraprep®CHG skin antisepsis- Chloraprep® Optimal site selection- avoid femoral Optimal site selection- avoid femoral
lineline Daily review of line necessityDaily review of line necessity Line maintenance- dressing changes, Line maintenance- dressing changes,
disinfection of access ports, limit disinfection of access ports, limit number of times it is accessed!number of times it is accessed!
Elements of Elements of Implementation Implementation
#1 Education#1 EducationMultidisciplinary TeamMultidisciplinary Team formed with members from; formed with members from;
ICIC
Executive Management, leaders from Critical Care,Executive Management, leaders from Critical Care,
Med/Surg, Anesthesia, Children’s, and frontline staff.Med/Surg, Anesthesia, Children’s, and frontline staff.
EducationEducation; ;
BarrierBarrier: : Large facilityLarge facility SolutionSolution: :
• Developed a computerized comprehensive education Developed a computerized comprehensive education program/s which is required by all who manage CVLsprogram/s which is required by all who manage CVLs
• Visual education- picture is worth a thousand words!Visual education- picture is worth a thousand words!
ICU Nurse’s Hands Pre-hand hygiene
Normal skin flora carried by the healthcare provider puts susceptible patients at risk
Clave Cultures
Before Alcohol Swab
After alcohol Swab (10 reps)
Swab it every time. Make it safe for your patient.
Elements of Elements of Implementation Implementation
#2 Standardize#2 Standardize BarrierBarrier: :
– Bundle Checklist: Initially taped on top of Bundle Checklist: Initially taped on top of each CVL kit- Misplaced, torn off, missingeach CVL kit- Misplaced, torn off, missing
SolutionSolution::– Developed custom kit that included Developed custom kit that included
checklist placed inside the kit and placed checklist placed inside the kit and placed checklist on intranetchecklist on intranet
– IV team responsible for dressing changes IV team responsible for dressing changes for all CVLsfor all CVLs
Elements of Elements of Implementation Implementation
#2 Standardize#2 Standardize BarrierBarrier: :
Issue’s with Daily Maintenance – Different Issue’s with Daily Maintenance – Different dressing change protocolsdressing change protocols
SolutionsSolutions::IV team responsible for dressing IV team responsible for dressing
changes for all patients with CVLschanges for all patients with CVLs
Elements of Elements of Implementation Implementation
#2 Standardize#2 Standardize
BarrierBarrier: “Daily Review of Line : “Daily Review of Line Necessity”Necessity”
SolutionsSolutions::• Added an area for documentation of “daily Added an area for documentation of “daily
review of line necessity” to the nursing flow-review of line necessity” to the nursing flow-sheetsheet
• Developed an electronic report of all patients Developed an electronic report of all patients with CVLs -automatically forwarded to the with CVLs -automatically forwarded to the nurse managersnurse managers
Elements of Elements of Implementation Implementation #3 Feedback of Data#3 Feedback of Data
• Unit specific infection data is forwarded Unit specific infection data is forwarded monthly to nurse managers and physician monthly to nurse managers and physician leaders. Information is shared with frontline leaders. Information is shared with frontline staffstaff
• Monthly compliance data is placed on each Monthly compliance data is placed on each area’s “report card” and posted in the area area’s “report card” and posted in the area
• This data is shared with frontline staff at staff This data is shared with frontline staff at staff meetings and monthly credentialing classes meetings and monthly credentialing classes
• Celebrate success! Celebrate success!
Outcome Measure: BSIs per 1,000 Line Days
0
1
2
3
4
5
6Ja
n-07
Feb-
07M
ar-0
7Ap
r-07
May
-07
Jun-
07Ju
l-07
Aug-
07Se
p-07
Oct
-07
Nov-
07De
c-07
Jan-
08Fe
b-08
Mar
-08
Apr-0
8M
ay-0
8Ju
n-08
Jul-0
8Au
g-08
Sep-
08O
ct-0
8No
v-08
Dec-
08Ja
n-09
Feb-
09M
ar-0
9Ap
r-09
May
-09
Jun-
09
Cent
ral L
ine
Asso
ciat
ed B
SIs
0
300
600
900
1200
1500
1800
Cent
ral L
ine
Days
Primary CLA-BSI (per CDC) CL Days
0
1
2
3
4
5
6
Jan-Mar 08
Apr-Jun
Jul-Sept
Oct-D
ec
Jan-Mar 09
Apr-Jun 09
Cen
tral
Lin
e In
fect
ion
s
50
100
150
200
250
300
350
400
450Infections Total Central Line Days
Success StoriesSuccess StoriesCSICU & NNICUCSICU & NNICU
0
1
2
3
4
5
6
Jan-Mar 08
Apr-Jun
Jul-Sept
Oct-D
ec
Jan-Mar 09
Apr-June
09
Cen
tral
Lin
e In
fect
ion
s
0
50
100
150
200
250
300
350
400
450Infections Total Central Line Days