ELLIS MEDICINECLABSI REDUCTION IN THE ICU

Eve Bankert, MTDirector of Infection Prevention

Kathleen Aidala, RN CCRNICU Nursing Quality & Education Specialist

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Background

•Sustained high CLABSI rates: 2007-2008

•Approx 50% of ICU patients have CVCs

•Hospital wide focus on “Culture of Safety”

•Identified opportunities for improvementTargeted initiatives vs. looking at discrete eventsOwnership of problem and processNeed for a multidisciplinary approachNeed for standardization

Initiatives

•CLABSI Task Force•Dressing Change Observations•ICU Unit Based Council•ICU Huddles•RN/IP Collaborative Rounds•Curos•CHG Bathing•New Hand Hygiene Campaign

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CLABSI TASK FORCE

• Created in 2007

• CLABSI case reviews

• New product review

• IV team report

• 2013 transitioned to IP Task Force

Ellis Hospital Infection Prevention CLABSI Worksheet Unit:

Patient Name: Age: Dx: MR#

Admit-d/c Date: Readmit Date: Bed Transfer Hx:

Inf. Date: Abx. Tx: #Cath. Days to Inf:

CLABSI Criteria:

Bld. Cx. (Date/Organism) #1 Bld. Cx. (Date/Organism) #2

S&S:

Chills Fever (>38C) Hypotension

Central Line (s):

CL #1 Type/Site Insert Date Inserter Insert Loc.

Emerg. Yes No Removal Date Tip Cx.

CL #2 Type/Site Insert Date Inserter Insert Loc.

Emerg. Yes No Removal Date Tip Cx.

Information to be completed by the unit designee:

Was the central line insertion checklist completed?

Were all elements of the bundle performed? Yes No Comments:

Was the Central Line assessment completed daily? Yes No

Was the exit site clear? Yes No Describe any site issues:

Was the Biopatch in place? Yes No

Were cap & dressing changes documented every 7 days? Yes No

Describe any dressing issues:

Was the patient on TPN? Yes No

Was the patient in Hemodialysis? Yes No

Date of last dialysis before onset of infection: Comments:

Date Case Reviewed: Findings:

ICU UNIT BASED COUNCIL• Initiated in 2012 in response to increased infection

rates

• Team leader is also ICU quality committee representative.

• Multidisciplinary team: ICU staff, NMs, physician, respiratory therapy, dietary & infection prevention.

• Meet once a month for an hour to review ICU infections

• Develop action plans to assist with decreasing infection rates

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•IV access ports have been associated with increased BSI rates•Peel off hanging strip (hung on every IV pole) twist on over access port•Physical barrier to contamination between line accesses. •Inside green cap 70% isopropyl alcohol saturated sponge.•Disinfects valve 3 minutes after application.• Can be left on for up to 7 days if IV site not used

CHG BATHING

•95% reduction in bacterial growth which decreased risk of hospital acquired infections.

•Although CHG can alter pH it is still maintained in the normal acidic range for skin flora.

•We still use basin for washing.

•Clean basin before and after use.

•Nothing is stored in wash basins.

HAND HYGIENE TASK FORCE Increase hand hygiene complianceCreate a sense of accountabilityEngage key stakeholders/ departmental championsEmbed hand hygiene in Ellis cultureIdentified as an organizational patient safety priorityMultidisciplinary collaborative approachEducation in what to say or do when someone is not in compliance

HIGH FIVE SAVES LIVES EDUCATIONAL MESSAGE

HOW

Give staff a friendly High Five as a reminder to do Hand Hygiene

ICU CLABSI RATES 2007-2013

Conclusions

• Culture of Safety must be our guiding force• Collaborative efforts= favorable outcomes• Sustainable practices a must for success• Employ initiatives that align with nationally

recognized standards• Teamwork!