Purpose

1. Central Line Associated Blood Stream Infections and Chlorhexidine Gluconate BathsA. Fisher SNJ. Canty SNL. Pollock SN

2. Purpose To decrease the rate of central line associated blood stream infections To increase knowledge on the purpose and effectiveness of chlorhexidine gluconate (CHG) baths in preventing CLABSI's To understand the proper documentation of CHG baths in Cerner

3. Background • Central Line: • An intravascular catheter that terminates at or close to the heart in one of the great vessels • Used for infusions, withdrawal of blood,  or hemodynamic monitoring • CLABSI: • A laboratory confirmed bloodstream infection where the central line was in place >2 calendar days on the date of the even

4. Chlorhexidine Gluconate Wipes Broad spectrum anti-microbial properties Works against MRSA and VRE Low toxicity Immediate and long-acting protection

5. National Patient Safety Goals 2014 • NPSG.07.03.01 • Use proven guidelines to prevent infections that are difficult to treat. • NPSG.07.04.01 • Use proven guidelines to prevent infection of the blood from central lines.

6. CLABSI Costs Medications, catheter changes, lab tests, ICU transfers Each CLABSI costs about $16, 550 per patient As of 2008, hospitals are not reimbursed by CMS for CLABSIs that were not present on admission

7. CLABSI Complications Between 12-15% of patients who acquire a CLABSI die Roughly 250,000 cases per year  62,000 patients die Extended hospital stays

8. CLABSI Rates Rizzo, E. (2014). • Bayfront CLABSI Rates: • Rate of Infection: 1.11 • Florida CLABSI Rates: • Rate of Infection: 0.57 • United States CLABSI Rates: • Rate of Infection: 0.56

9. Improvement Tools & Methods Plan-Do-Study-Act Improvement Method Cause & Effects Analysis- Fishbone Diagram Process Flow Charting

10. Cause & Effect Analysis

11. Process Flow Chart

12. Team Members Nurse Manager Registered Nurses Patient Care Techs PICC Nurses

13. Measures Track the number of line days for each patient with a central line Documentation of chlorhexidine gluconate baths given to patients with a central line Track and document the patients that develop central line associated blood stream infections

14. Process Improvement • Results for CLASBI indicate a 53% rate reduction during CHG intervention (Karki 2012) • In one community hospital, CLASBI rates decreased from 3.8 to 1.6 per 1000 central line days, in 6 months of beginning the CHG bath intervention (Miller 2012) • VISION • CLASBI is largely preventable and a rate of ZERO is an achievable goal (Miller 2012)

15. Process Improvement • Proper Techniques to Perform CHG Baths: • CHG wipes should not come into contact with eyes or ears • Only use CHG wipes below the jaw line • Use a firm massage to remove bacteria • Use a new cloth for each area of the body • Let CHG air dry- do not wipe or rinse off • Do not use soap and water on the skin after CHG baths • Dispose of CHG wipes in the trash DO NOT flush • CHG baths should be given DAILY

16. Process Improvement

17. Documentation in Cerner

18. Limitations & Lessons Learned Float nurses will need to be educated about the CHG bath protocol for patients with central lines

19. References Centers for Disease Control and Prevention, (2014). Central line associated blood stream infection event. Retrieved from website: http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf Centers for Disease Control and Prevention. (2011). Vital signs: Central line-associated blood stream infections . Morbidity and Mortality Weekly Report, 60, 1-6. Retrieved from http://www.cdc.gov/mmwr/pdf/wk/mm60e0301.pdf Centers for Medicare and Medicaid Services. (2008, October 01). Hospital-acquired conditions (present on admission indicator). Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html?redirect=/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp

20. References Karki, S., & Cheng, A. (2012). Impact of non-rinse skin cleansing with chlorhexidinegluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. Journal Of Hospital Infection, 82(2), 71-84. doi:10.1016/j.jhin.2012.07.005 Miller, S., & Maragakis, L. (2012). Central line-associated bloodstream infection prevention. Current Opinion In Infectious Diseases, 25(4), 412-422. The Joint Commission. (2014). Hospital national patient safety goals. Retrieved from http://www.jointcommission.org/assets/1/6/2014_HAP_NPSG_E.pdf The Joint Commission. Preventing Central Line–AssociatedBloodstream Infections: A Global Challenge, a GlobalPerspective. Oak Brook, IL: Joint Commission Resources, May 2012. http://www.PreventingCLABSIs.pdf. The Leapfrog Group. (2013, October). Retrieved from Hospital safety score: http://www.hospitalsafetyscore.org/hospital/bayfront-medical-center-inc Rizzo, E. (2014). Infection control & clinical quality. Beckershospital review. Shaffer, J. (2012). Bathing with chlorhexidine (chg) cloths . Infection Control and Epidemiology, Retrieved from http://www.med.umich.edu/1libr/infectioncontrol/CHG.pdf World Health Organization. (2014). Preventing blood stream infections from central line venous catheters . Retrieved from http://www.who.int/patientsafety/implementation/bsi/en/