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Central Line Associated Bloodstream Infection Prevention is Primary!. Tennessee Collaborative Reducing Healthcare Associated Infections Erlanger Health System Implementation. Erlanger Health System. Level 1 Trauma Center 4 Inpatient Campuses 564 Inpatient Beds - Adult and Pediatrics
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Central Line Associated Bloodstream Infection Prevention is Primary! Tennessee Collaborative Reducing Healthcare Associated Infections Erlanger Health System Implementation
Erlanger Health System • Level 1 Trauma Center • 4 Inpatient Campuses • 564 Inpatient Beds - Adult and Pediatrics • 7 Adult ICUs with 66 beds • 50 bed Neonatal ICU • 8 bed Pediatric ICU – expanding to 12 beds
CLA-BSI Prevention “Erlanger Timeline” • 1999 Implemented CHG skin prep for CVL insertions and site care and use of antimicrobial impregnated CVL in TICU • 2000- 2001 Implemented use of CHG skin prep and antimicrobial impregnated CVL in other ICUs • 2002 Standardized central line dressing change kit and site care • 2003 Implemented new central line insertion kits to include all items for the procedure including; • Full Sheet drape • Chloraprep™ • Safety devices
CLA-BSI Prevention“Erlanger Timeline” • 2006 Central Line checklist implemented • 2007 Development of poster to show the major points related to CVL insertion and placed on all patient care units • 2008-09 Participation in the statewide initiative to reduce healthcare associated infections
“Bundle Components” • Hand Hygiene • Maximal sterile barriers • CHG skin antisepsis- Chloraprep® • Optimal site selection- avoid femoral line • Daily review of line necessity • Line maintenance- dressing changes, disinfection of access ports, limit number of times it is accessed!
Elements of Implementation #1 Education Multidisciplinary Teamformed with members from; IC Executive Management, leaders from Critical Care, Med/Surg, Anesthesia, Children’s, and frontline staff. Education; • Barrier: Large facility • Solution: • Developed a computerized comprehensive education program/s which is required by all who manage CVLs • 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 Implementation #2 Standardize • Barrier: • Bundle Checklist: Initially taped on top of each CVL kit- Misplaced, torn off, missing • Solution: • Developed custom kit that included checklist placed inside the kit and placed checklist on intranet • IV team responsible for dressing changes for all CVLs
Elements of Implementation #2 Standardize • Barrier: • Issue’s with Daily Maintenance – Different dressing change protocols • Solutions: • IV team responsible for dressing changes for all patients with CVLs
Elements of Implementation #2 Standardize • Barrier: “Daily Review of Line Necessity” • Solutions: • Added an area for documentation of “daily review of line necessity” to the nursing flow-sheet • Developed an electronic report of all patients with CVLs -automatically forwarded to the nurse managers
Elements of Implementation #3 Feedback of Data • Unit specific infection data is forwarded monthly to nurse managers and physician leaders. Information is shared with frontline staff • Monthly compliance data is placed on each area’s “report card” and posted in the area • This data is shared with frontline staff at staff meetings and monthly credentialing classes • Celebrate success!
