ELLIS MEDICINE

CLABSI REDUCTION IN THE ICU

Eve Bankert, MT Director of Infection Prevention Kathleen Aidala, RN CCRN ICU Nursing Quality & Education Specialist

Background

•Sustained high CLABSI rates: 2007-2008 •Approx 50% of ICU patients have CVCs •Hospital wide focus on “Culture of Safety” •Identified opportunities for improvement  Targeted initiatives vs. looking at discrete events  Ownership of problem and process  Need for a multidisciplinary approach  Need 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 2

CLABSI TASK FORCE

•

Created in 2007

•

CLABSI case reviews

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New product review

•

IV team report

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2013 transitioned to IP Task Force

Ellis Hospital Infection Prevention CLABSI Worksheet

Unit: Patient Name: Admit-d/c Date: Inf. Date: Chills Abx. Tx: CLABSI Criteria: Bld. Cx. (Date/Organism) #1

S&S

: Readmit Date: Age: Dx: Bld. Cx. (Date/Organism) #2 Fever (>38C) Bed Transfer Hx: MR# #Cath. Days to Inf: Hypotension Central Line (s): CL #1 Type/Site Emerg. Yes No Removal Date Insert Date CL #2 Type/Site Insert Date Inserter Tip Cx. Inserter 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?

Was the Central Line assessment completed daily?

Yes

Yes No Comments: No Was the exit site clear? Yes Was the Biopatch in place?

No Describe any site issues:

Yes

No

Were cap & dressing changes documented every 7 days?

Describe any dressing issues:

Yes No

Was the patient on TPN? Yes

Was the patient in Hemodialysis?

No

Yes No Date of last dialysis before onset of infection: Comments: Date Case Reviewed: Findings:

Insert Loc. Insert Loc.

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

12/03/2012 12/3 – 12/5 Deborah Trawick 518-243-1954

•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 10

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 compliance Create a sense of accountability Engage key stakeholders/ departmental champions Embed hand hygiene in Ellis culture Identified as an organizational patient safety priority Multidisciplinary collaborative approach Education 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

0,8 0,6 0,4 0,2 0 2 1,8 1,6 1,4 1,2 1

ICU CLABSI RATES 2007-2013

3,4 3,2

Ag coate d TLC

3 2,8

CHG for insertion Standardize Insertion

2,6 2,4 2,2

Daily rounding CL insertion checklist Ag V link 2007 2008 2009 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 CHG bathing Curos High Five campaign Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 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!