Transcript Preventing Central Line Infections

Reducing Central Line-Associated
Bloodstream Infections
Implementing Central Line Care Bundle
Marleen C. Michael, RN CIC
Infection Control Coordinator
Mary Eschete, MD
IC Committee Chairman
Peggy Glanders, RN
Infection Control Coordinator
Central Line-Associated Bloodstream Infection
(CLABSI) Facts




CDC reports an estimated 250,000 CLABSI’S
occur each year
Attributable mortality is an estimated 12-25%
per infection
Prolongs hospital stays by an average of 7
days
Attributable cost per infection is an estimated
$29,156.
Central Line-Associated Bloodstream
Infection Risk Factors






Prolonged hospitalization prior to insertion
Prolonged duration of catheter
Heavy bacterial colonization at insertion site
and catheter hub
Neutropenia
Internal jugular and femoral catheterization
Substandard care of the catheter and
insertion site
Infection Prevention Guidelines






Centers for Disease Control (CDC)
Infectious Disease Society of America (IDSA)
Society for Healthcare and Epidemiology
(SHEA)
Association for Professionals in Infection
Control (APIC)
Institute for Healthcare Improvement (IHI)
The Joint Commission (TJC) National Patient
Safety Goals
Goals and Plan

Significantly reduce rate of central line infections,
increase patient safety and reduce
morbidity/mortality in addition to realizing a cost
savings.





Perform risk assessment and evaluate CLABSI data
Utilize best practices by implementing Central Line Bundle
Comply with TJC National Patient Safety Goal
Continually re-evaluate CLABSI data and provide feedback
of outcomes down to the unit level
Meet or be below benchmark data from NHSN
What is the Central Line Bundle?


Group of evidence-based interventions and
best practices for patients with intravascular
central catheters that, when implemented
together, result in better outcomes than when
implemented individually.
Must be used as an all or none strategy for
optimal results.
Central Line Bundle Core Components

Hand Hygiene


Maximal Barrier Precautions



Mask, cap, sterile gown and gloves
Large sterile full body drape
Skin Antisepsis


Before and after touching catheter or site
Chlorhexidine prior to insertion and for site care
Optimal Site Selection


Subclavian vein
Avoid femoral and internal jugular
Central Line Bundle Core Components

Catheter Hub Disinfection


Scrub the hub for at least 15 seconds with alcohol
CHG Site Dressings
Additional Measures to Bundle


Staff education via web-based modules
Patient education







Patient Safety Handbook – UMC
Patient education sheet - LJC
Central Line Insertion/Safety Checklists
Daily chlorhexidine baths for ICU patients
Policy Development
All-inclusive central line kits and supplemental
barrier precautions kits
Daily line necessity review - UMC
Central Venous Catheter Line Days
line days
1200
1103
1000
800
861
797
600
555
400
200
0
2007
2008
2009
2010
Central Line Bundle Compliance
96
95
94
92
90
90
88
87
87
86
84
82
2007
2008
2009
2010
 Masking of procedure assistants along with site
selection have been most common reason for compliance failures.
 Site selection has improved.
Increasing Bundle Compliance




Extensive education to physicians and nurses.
Including new, incoming physicians
Physician noncompliance reported to Infection
Control, Medical Executive and Executive
Steering Committees
Taped insertion checklist to catheter kits
Infection Control makes rounds daily on
inpatient units
2006-2010 ICU Infection Rates
Incidence Rate
12
10
10.9
9.6
8
10.5
8.8
6.1
6
4
2
0
2006
2007
2008
2009
0
2010 1st qtr
Number of Infections
14
12
10
8
6
12
9
7
7
4
2
4
0
2006
2007
2008
2009
2010
2010 2nd
QTR
Estimated Mean ICU CLABSI Cost
$450,000
$349,872
$400,000
$350,000
$262,404
$300,000
$250,000 $204,092
$200,000
$116,624
$150,000
$100,000
$50,000
$0
2006 & 2008
2009
2010
2007
*Based on estimated mean cost of $29,156 per infection
Areas for Improvement




Increase compliance for daily reviewing of line
necessity
Catheter hub disinfection
Increase compliance with checklist completion
Hand hygiene compliance
ICU/NICU Central Venous Catheter Line Days
line days
2000
1500
1899
1661
1406
1185
1162
1000
500
0
2006
2007
2008
2009
2010
Central Line Safety Checklist Compliance
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
r
c
b
n
De Ja Fe Ma
Compliance
r
y
Ap Ma
n
Ju
l
Ju Aug Sep Oct Nov Dec
with utilizing the checklist at LJC has increased
from 53.8% in December 2009 to 86.6% in December 2010.
Compliance with Bundle Components
Compliance
with using CHG antiseptic for skin prep increased from
48.1% in January to 100% in December.
Compliance
with using Maximum Barrier precautions increased from
77.8% in January to 100% in December.
Compliance
with Femoral Vein avoidance has increased from 88.9% in
January to 100% in December.
Compliance
with using a CHG dressing has increased from 55.6% in
January to 100% in December.
Compliance
with documentation of patient education has increased from
18.2% in January to 60.9% in December.
2009-2010 ICU/NICU Infection Rates
ICU/NICU Incidence Rate 2009
16
14
12
10
8
6
4
2
0
ICU/NICU Incidence Rate 2010
13.7
12.05
12.61
12.12
8.62
6.9
0
Jan
The
0
Feb
0
Mar
0
0
Apr May
0
Jun
0
0
0
Jul
Aug Sep
7.46
0
0
0
Oct
Nov Dec
ICU/NICU annual rate decreased from
5.69/1000 device days in 2009 to 1.72/1000
device days in 2010.
2009-2010 Hospital-Wide CLABSI’s By Number of Infections
Number of Infections ICU/NICU 2009
Number of Infections Hospital-wide 2010
3.5
3
2.5
2
1.5
1
0.5
0
The
3
2
1
0
Jan
1
0
Feb
0
Mar
1
0
Apr
0
May
2
1
0
Jun
0
Jul
0
0
Aug Sep
1
0
Oct
1
0
0
Nov Dec
2010 Hospital-wide annual rate is 2.04/1000 device days which is lower than the
ICU/NICU 2009 rate of to 5.69/1000 days.
There were no central line-associated bloodstream infections for 8 consecutive months
following the practice change. The two infections that occurred in October were related to
lines that were inserted under sub-optimal conditions. One line was inserted in a femoral
vein at another facility secondary to trauma. The other line was inserted emergently in a
patient that coded in the Ultrasound department.
Estimated Mean ICU/NICU CLABSI Cost
$250,000
$233,248
$200,000
$150,000
$100,000
$58,312
$50,000
$0
2009
*Based on estimated mean cost of $29,156 per infection
2010
Areas for Improvement





Increase compliance with documentation of patient
education.
Increase compliance with checklist completion.
Increase compliance with documentation of Hand
hygiene compliance.
Educate staff to re-insert lines that are inserted under
sub-optimal conditions as soon as feasible.
Increase compliance by daily reviewing of line necessity.