Central Line Bundle Brochure - Achieving Excellence in Patient Care Brochure Highlights and Contact Information

Goal: Preventing central line infections Focus: Central Line Bundle Hand Hygiene - Epi-Clenz Gel: MSC097030 (4 oz. bottle, 24ea/cs) MSC097031 (4 oz. bottle, breezia fragrance, 24ea/cs) MSC097033 (16 oz. pump 12ez/cs) MSC097034N (1.5 oz. flip cap w/ neck strap, 48ea/cs) Epi-Clenz Foam: MSC097040 (8 oz. bottle, 24ea/cs) MSC097041 (1.5 oz. bottle, 48ea/cs) MSC097042 (16 oz. bottle, 12ea/cs) Sterillium: MSC097060 (1000mL, 8ea/cs) Maximal Barrier Precautions: Full Body Drape: DYNJP4117 (10ea/cs) Maximal Barrier Precautions Kit: DYNJP4120 (6ea/cs) Chlorhexidine Skin Antisepsis: Central Line Change Tray: DYND75222 (40ea/cs) DYND75223 (40ea/cs) Optimal Catheter Site Selection: Full Body Drape -One Drape-One Solution for Multiple Access Points: DYNJP4117 (10ea/cs) DYNJP4120 – Kit (6ea/cs) Daily Review of Central Line Necessity:

Daily Review-Intravenous Access Record is included in the Brochure along with Policy & Procedure, Competency Statement, Skills Checklist, and Central Line Insertion Checklist

A Draping Application guide is also available through Medline University at www.medline.com Contact Information: For more information on ordering the Central Line Drape or the Central Line Insertion Kit please contact Frank Czajka at (847) 775-6051 or fczajka@medline.com For more information on ordering hand hygiene products please contact April Niemi at (847) 643-4329 or aniemi@medline.com For more information on ordering our Central Line Dressing Change Tray please contact Jim Moorman at (847) 949-2262 or jmoorman@medline.com For clinical support, please contact Alecia Cooper, RN, MBA, CNOR, at (847) 643-4359 or acooper@medline.com

Achieving Excellence in Patient Care

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Achieving Excellence in Patient Care

Lives Campaign

MKT205258/LIT #424/1M

Lives Campaign

Proxima Full Body Central Line Drapefor Maximal Barrier Protection

One Drape-One Solution

Achieving Excellence in Patient CareThree Important National Initiatives

100klives

JCAHO 2006 National PatientSafety Goals for Hospitals

• Improve the accuracy of patient

identification.

• Improve the effectiveness of

communication among caregivers.

• Improve the safety of using medications.

• Reduce the risk of health care-

associated infections.

• Accurately and completely reconcile

medications across the continuum of

care.

• Reduce the risk of patient harm resulting

from falls.

Surgical Care Improvement Project(SCIP): Four Target Areas

1. Surgical site infections

• Antibiotics, blood sugar control,

hair removal, normothermia

2. Perioperative cardiac events

• Use of perioperative beta-blockers

3. Venous thromboembolism

• Use of appropriate prophylaxis

4. Ventilator-associated pneumonia

• Head of bed elevated, rapid

weaning protocol, PUD prophylaxis

100,000 Lives Campaign: Six Changes for Improving Care

1. Deploy rapid response teams at the first sign

of patient decline.

• Monitor vital signs, blood oxygen, urine

output, mental function

2. Prevent deaths from heart attack by

delivering evidence-based care for acute

myocardial infarction.

• Aspirin, beta-blocker, ACE-inhibitor/ARB,

reperfusion, smoking cessation

3. Prevent adverse drug events (ADEs) by

implementing medication reconciliation.

• Verify, clarify, and reconcile patient

medications

4. Prevent central line infections by

implementing the “Central Line Bundle.”

• Hand hygiene, maximal barrier

precautions, skin antisepsis, catheter

site selection, daily review

5. Prevent surgical site infections by delivering

the correct perioperative care.

• Antibiotics, hair removal, glucose

control, normothermia

6. Prevent ventilator-associated pneumonia by

implementing the “Ventilator Bundle.”

• Head of bed elevated, daily assessment,

PUD prophylaxis, DVT prophylaxis

THE CENTRAL LINE BUNDLE

PRODUCT LISTS & INFO

Epi-Clenz™ instant hand sanitizer with ethyl

alcohol kills 99.9% of common germs. It is available

in convenient gel and foam versions, both with

added moisturizers that leave hands feeling soft.

Sterillium® Rub is another alcohol-based hand

antiseptic that works with out water to kill bacteria.

It also contains emollients for skin protection and

is available in an automatic touch-free dispenser.

Medline offers a full-body drape with multiple

access points and peel-off fenestration covers

for versatility and ease of use. (See the enclosed

information sheet on the Proxima central line

drape.)

Maximal Sterile Barrier Precautions Kit:

Bouffant cap, face mask, sterile gown, CSR wrap,

and Full Body Drape are also available from

Medline in a kit.

ChloraPrep® friction applicators provide a

convenient way to scrub insertion sites with a

2% chlorhexidine/ 70% isopropyl alcohol

solution, which has been proven more effective

than povidone-iodine and is recommended by

the CDC as well as the 100,000 Lives Campaign

Daily Central Line Review Sheet

(See the enclosed sheet inside the pocket

folder)

ITEM NUMBERS

Epi-Clenz gel is MSC097030,

MSC097031, MSC097032,

MSC097033, MSC097034n

Epi-Clenz foam is

MSC097040, MSC097041,

MSC097042

Sterillium is MSC097060

DYNJP4117 Full Body Central

Line Drape

DYNJP4120 Maximal Sterile

Barrier Precautions Kit

Available February 2006

DYND75222 Central Line

Change Tray

DYND75223 Central Line

Change Tray

DYNJP4117 Full Body Central

Line Drape

FIVE COMPONENTS OF CARE

Hand Hygiene

Maximal Sterile Barrier Precautions

Chlorhexidine Skin Antisepsis

Optimal Catheter

Site Selection

Daily Review of

Central Line Necessity

Proxima Full Body Central Line Drape

Two for jugular,

subclavian

or femoral

Two for brachial,

antecubital,

or radial

And PICC Lines

ACHIEVING EXCELLENCE IN PATIENT CARE

GOAL: Preventing central line infections

FOCUS: Central Line Bundle

• Hand Hygiene

• Maximal Barrier Precautions

• Skin Antisepsis

• Catheter Site Selection

• Daily Review

• Approximately 250,000 central venous catheter-related bloodstream infections occur each year in U.S. hospitals,

with associated mortality of 12% to 25%.

• In ICUs, these infections cause an estimated 14,000 to 28,000 deaths per year.

• Additional cost to the healthcare system is approximately $25,000 per infection.

• On average, a bloodstream infection adds seven days to a hospital stay.

TARGETED BY PATIENT CARE INITIATIVES

• The Institute for Healthcare Improvement’s 100,000 Lives Campaign names prevention of central line infections

as one of six changes for improving care.

• The JCAHO 2006 National Patient Safety Goals for Hospitals include “reduce the risk of health care-associated

infections” as goal #7.

A PLAN FOR PREVENTION

The 100,000 Lives Campaign recommends implementing a set of evidence-based interventions, together called the

“Central Line Bundle,” to reduce the occurrence of central line infections.

POTENTIAL IMPACT OF INTERVENTIONS

A four-year study in Pennsylvania found a 68% reduction in bloodstream infections among ICU patients after implement-

ing a group of care components similar to the “central line bundle.”

SUPPORT FROM CDC AND APIC:

• Recommendations in the CDC’s Guidelines for the Prevention of Intravascular Catheter-Related Infections are similar to

those in the Central Line Bundle.

• According to APIC, “The elements of this central line bundle are identical to those stressed and taught by the

Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) and the Healthcare Infection

Control Practices Advisory Committee (HICPAC).”

References

CDC. Guidelines for the Prevention of Intravascular Catheter-Related Infections. MMWR 2002:51(RR-10).

IHI. Getting Started Kit: Prevent Central Line Infections. www.ihi.org.

APIC. Preventing Central Line-Associated Bloodstream Infections. 2005.

CDC. Reduction in Central Line-Associated Bloodstream Infections Among Patients in Intensive Care Units—Pennsylvania,

April 2001–March 2005. MMWR 2005:54(40).

PRACTICE GUIDELINES

PRODUCT INFORMATION

Proxima Full-Body Central Line DrapeAn important part of Maximal Barrier Precautionsin the fight against central line infections.

“Catheter-related septicemias

are six times lower when maximum

sterile barriers are used during

central line insertion.”1

1 Raad, II, Hohn DC, Gilbreath BJ, et al. Prevention of central venous catheter-related infections by using maximal

sterile barrier precautions during insertion. Infection Control and Hospital Epidemiology. 1994;15(4 Pt 1):231-238.

2 Centers for Disease Control and Prevention. Guidelines for the Prevention of Intravascular Catheter-Related

Infections. MMWR 2002:51(RR-10).

3 Institute for Healthcare Improvement. Getting Started Kit: Prevent Central Line Infections. www.ihi.org.

The role of maximal barrier precautions in preventing central line infections:

The use of maximal barrier precautions (i.e., cap, mask, gown, gloves, and

full-body drape) when inserting central lines is supported by research and

recommended by current patient care initiatives.

• A study of cancer center patients found that the use of maximal

barrier precautions during central venous catheter insertion

reduced the risk of bloodstream infections. When only gloves and a

small drape were used, the risk of infection was 6.3 times greater.1

• CDC guidelines recommend “aseptic technique including the use of

a cap, mask, sterile gown, sterile gloves, and a large sterile sheet for

the insertion of CVCs [central venous catheters].”2

• The 100,000 Lives Campaign also recommends maximal barrier

precautions, including “covering the patient from head to toe with a

sterile drape, with a small opening for the site of insertion.”3

The Proxima central line drape: A maximum sterilebarrier with added features for convenience.

• Provides full-body coverage in accordance with current guidelines

for preventing central line infections.

• Multiple access points for convenience and versatility.

• Clear peel-off fenestration covers

are easy to open and allow visualization of

insertion sites prior to positioning.

• Large reinforced absorbent area

surrounding access points.

• Reversible design allows positioning

for femoral, subclavian or additional

peripheral access sites.

Exclusive clear peel-off fenestration covers

Multiple AccessPoints For ConvenienceAnd Versatility

Two for jugular, subclavian

or femoral

Two for brachial, antecubital,

or radial

One Drape – One SolutionAll Access Sites

One Drape – One Solution

120" (305cm)

77" (196cm)

DYNJP4117

POLICY & PROCEDURE

PREVENTION OF CENTRAL LINE INFECTIONS BY

IMPLEMENTING THE "CENTRAL LINE BUNDLE":

• HAND HYGIENE

• MAXIMAL BARRIER PRECAUTIONS

• SKIN ANTISEPSIS

• CATHETER SITE SELECTION

• DAILY REVIEW

POLICY STATEMENT:

To reduce the patient's risk of acquiring an intravascular catheter-related infection following insertion of a central

venous or pulmonary catheter through the use of a "Central Line Bundle" protocol that outlines appropriate hand

hygiene, maximal sterile barriers, chlorhexidine skin antiseptic, catheter site selection, and daily review.

PURPOSE:

Because central line catheters provide direct vascular access to patients for the administration of fluids/medica-

tions, blood products, blood sampling, and hemodynamic monitoring, they disrupt skin integrity, making infection

with bacteria and/or fungi possible. Infection may spread to the bloodstream, causing sepsis with hemodynamic

changes, organ dysfunction, and ultimately death.1 Studies suggest that bloodstream infections (BSIs) are a seri-

ous complication affecting between 87,500 and 350,000 patients annually and are associated with high mortali-

ty and excess costs.2

HAND HYGIENE:

Caregivers should wash hands (or use an alcohol-based waterless cleanser) before and after inserting or other-

wise handling an intravascular catheter, as well as before and after palpating insertion sites.

MAXIMAL BARRIER PRECAUTIONS:

Before placing a central line, caregivers should don a cap, mask, sterile gown, and gloves. In addition, they should

cover the patient’s entire body with a sterile drape, leaving only a small opening at the insertion site.

Skin Antisepsis:

Skin should be scrubbed with a solution containing 2% chlorhexidine/ 70% isopropyl alcohol and

allowed to dry completely before the site is punctured.

on the reverse side:

• Catheter Site Selection

• Daily Review

• Maximum Sterile Barrier Procedure

Catheter Site Selection:

The subclavian vein is the preferred site for nontunneled catheters in adults and should be used whenever possible

instead of the jugular or femoral site.

Daily Review:

Lines that are no longer clearly needed should be removed promptly.

Maximal Sterile Barrier Procedure:3

1. Place surgical cap on head to cover all hair and then place surgical mask.

2. Cleanse hands according to hospital recommended policy and procedure.

3. Aseptically don surgical gown.

4. Aseptically don surgical gloves.

5. Prep catheter insertion site with ChloraPrep.

6. Place full-body sterile drape to cover patient aseptically while maintaining the sterile field.

References:(1) Earsing, KA, Baugher-Hobson, D, White, KM. Preventing Central Line Infection. Nursing Management, October 2005.

(2) Braum, BI, Kritchevsky, SB, et al. Preventing Central Venous Catheter-Associated Primary Infection. Infection Control

and Hospital Epidemiology, December 2003.

(3) Association of Perioperative Registered Nurses. 2005 Standards, Recommended Practices and Guidelines. Denver, CO, 2005.

COMPETENCY: CENTRAL LINE BUNDLE

MEASURABLE CRITERIA

Good hand hygiene can be achieved

through the use of either a water-

less, alcohol-based product or an

antibacterial soap and water with

adequate rinsing.

Implementation of maximal sterile

barrier precautions during the inser-

tion of central line catheters has

been shown to substantially reduce

the incidence of catheter-related

bloodstream infections as compared

with sterile precautions (e.g., sterile

gloves and small drape).

Optimal skin antisepsis is achieved

when skin is prepared with a solution

containing 2% chlorhexidine/ 70%

isopropyl alcohol and allowed to dry

completely before the site is

punctured.

Authorities recommend that central

venous catheters be placed in a

subclavian site instead of a jugular

or femoral site to reduce the risk of

infection.

A daily review of the catheter

patency and insertion site is

necessary, combined with the daily

question, "Is this catheter necessary

or can it be removed?"

RATIONALE

The purpose of good hand hygiene

is to remove debris and transient

microorganisms from the hands, to

reduce resident microbial count to a

minimum, and to inhibit rapid

rebound growth of microorganisms.

Personnel within a sterile field

should wear caps, masks, and sterile

gowns and gloves to prevent

microorganisms from being

transferred to the catheter insertion

site during the procedure.

Infection can occur due to a high

microbial count at the catheter

insertion site.

The density of skin flora at the

catheter insertion site is a major risk

factor for catheter-related blood

stream infections.

Lines that are no longer clearly

needed should be removed promptly

to eliminate the potential for catheter-

related bloodstream infections.

COMPETENCY STATEMENT &

SKILLS VALIDATION TOOL

COMPETENCY STATEMENT

Good hand hygiene before central

line insertion, combined with proper

aseptic technique during catheter

placement, has been proven to

provide protection against infection.

Maximal sterile barrier precautions

include a surgical cap, mask, sterile

gown, sterile gloves, and a full-body

sterile drape during the insertion of

central line catheters.

Proper skin antisepsis is critical

prior to insertion of central line

catheters to reduce local skin flora

and to prevent rapid rebound

growth of microorganisms on the

skin’s surface following catheter

insertion.

The site at which a catheter is

placed influences the subsequent

risk for catheter-related infection

and phlebitis.

Daily review of central lines is a

necessity, with documentation in the

medical record.

SKILLS VALIDATION CHECKLIST: CENTRAL LINE BUNDLE

EMPLOYEE’S NAME: DATE:

REVIEWED DEMONSTRATED

TASK DATE/INITIALS DATE/INITIALS COMMENTS

1. Identify self

2. Identify patient

3. Explain procedure to patient

4. Obtain signature for informed consent.

5. Wash Hands

6. Gather necessary equipment:

Central line bundle kit

Central line catheter kit

7. Provide for Privacy (pull curtain, close door)

8. Position patient to allow for visualization of

surgical site.

9. Assess patient's skin at insertion site prior to

skin preparation. Assess for moles, warts, rashes,

hair, and other skin conditions at the surgical site.

10. Remove any hair if ordered by physician.

11. Document skin assessment in the patient's record.

12. Assemble equipment and verify supplies.

13. Apply surgical hat and mask and secure in place.

14. Wash hands with approved antiseptic agent.

15. Don a sterile surgical gown and gloves aseptically.

16. Prep procedure site with ChloraPrep®. Allow 30 sec.

prep time & 30 sec. dry time for a dry site & 2 min.

prep time and a 1 min. dry time for a moist site.

17. Apply full-body drape aseptically to establish the

maximal barrier. Remove tab from insertion site.

18. Maintain a sterile field during the catheter

insertion.

18. Order followup Radiology images if ordered by

physician.

19. Utilize sterile technique when applying the

dressing to the catheter insertion site.

20. Date the dressing site.

21. Document procedure and patient tolerance in

the medical record.

22. Add IV site to appropriate flowchart(s).

CENTRAL LINE INSERTION CHECKLIST

Line type Location Site Appearance Procedure

1. Peripheral 1. Left Hand 1. Site unremarkable 1. I.V. Start/Restart

2. PICC 2. Right Hand 2. Slightly pink or painful 2. Dressing change

3. Midline 3. Left forearm 3. Painful: slightly red 3. Cap Change

4. Multi Lumen 4. Right forearm 4. Painful: erythema, swelling 4. Central Line placement

5. Port-a-cath 5. Left upper arm 5. Purulent drainage 5. Discontinued line

6. Dialysis 6 Right Upper Arm 6. Serous drainage 6. De-clot therapy

7. Hickamn 7. Left Chest 7. Serosanguanous drainage 7. Tubing change

8. Swan Ganz 8. Right chest 8. Sutures intact 8. Port-a-cath access

9. Cordis 9. Left neck 9. Cording palpable 9. Port-a-cath de-access

10. Other 10. Right neck 10. Other 10. I.V. securement applied(see comments) 11. Left foot (see comments) 11. Other

12. Right foot (see comments)

13. Other(see comments)

INTRAVENOUS ACCESS RECORD

Date/Time Line Type Location IV Access Site Procedure Signature Next

of Line Gauge Attempts Appearance Activity

Comments

Comments

Comments

Comments

Comments

Comments

Comments

MAXIMUM BARRIER DRAPING APPLICATION GUIDE

DYNJP4117 Proxima Full Body Central Line Drape

Remove the carrier paper from the back of the insertion fenestration that will be utilized

to insert the catheter.

Unfold the drape to the right and to the left as indicated on the

drape to cover the patient's body and then unfold the drape to

the head and then to the foot. Assure the patients entire body

is covered and that the insertion site is exposed for proper

catheter placement

Assure the proper orientation of the drape over the patient according to the designated

catheter insertion site and place the folded drape over the patient at midline.

Remove the plastic film covering the selected insertion fenestration to provide access.

You are now ready for insertion of the central line catheter.

STEP

1

STEP

2

STEP

3

STEP

4

STEP

5

Open the package containing the Full Body Drape using aseptic

technique and place the drape on an established sterile field.

The sterile field can be established by using the inside wrapper

containing the drape. It is recommended that the person

applying the drape have also adhered to hand hygiene and full

barrier precautions, including hat, mask, sterile gown, and sterile

gloves prior to applying the drape. The applicator should then

note the specific orientation instructions stamped onto the drape.