Transcript CLBSI: Working Toward Zero

CLABSI: Working Toward Zero
Trinity Regional Health System
Infection Prevention and Control
Presented by: Patricia Herath, BSN, RNC
Infection Preventionist
April 20, 2010
Central Line Associated Bloodstream
Infection (CLABSI) History


2006: 45 CLABSI = Rate of 7.7 per 1000 line days
2007: 9 CLABSI = Rate of 1.0 per 1000 line days


2008: 15 CLABSI = Rate of 1.9 per 1000 line days


Developed Central Line Insertion Bundle
Developed Central Line Maintenance Bundle
2009: 3 CLABSI = Rate of 0.4 per 1000 line days
Aim


Launched a
focused initiative
to reduce CLABSI
Zero rate was
targeted using the
IHI bundle check
list
Initial Action Plan


Formed multidisciplinary team to track and
evaluate central lines from insertion to discharge
Tracked insertion bundle compliance for Central
Lines



Physician champions
Use of Chlorhexidine Gluconate (CHG)– prep and
biopatch
Audited insertion bundle check sheets



Central lines
Included PICC lines
Ramped up Hand Hygiene education
Identified Issues
Concerns related to:
 Although insertion bundle was followed,
additional cases were noted
o Observed non-standardized approach to
line maintenance
o Identified documentation issues
o Identified issues relating to maintenance
(daily care)
Additional Action Plan

In-serviced oncology office staff
regarding standardized evidence
based practice care


Standardizing dialysis catheter dressing
changes
Developed an evidence based
daily maintenance bundle for
care of Central lines (April 2009)
Additional Action Plan (cont.)

Staff Education
Documentation
 Observation of sites,
daily care and
discontinuance


PICC nurses started
evaluation of daily
care by direct
observation
Lessons learned

TMC went 9 months with out a HAI – CLABSI


Real time reporting to CL team with each
finding




One in February 2010
Identified possible competency issue with care of
line
Manager to review care with the unit’s staff
2010 Rate First Quarter= .05
Continued commitment on Director level

Disseminated throughout the entire team
Outcome



Average cost of
CLABSI = $20,000
2006 – 2009 = 72
x $20,000 =
$1,440,000
Reduction of costs
with 0 rate
Future Direction



Evidence based standardized
approach to central line blood draws
Implement program to identify
patients at high risk with strategies
to mitigate risk
Develop analytic committee

Preventative vs. reactive
Acknowledgements

A special thanks is
extended to the
CLABSI team for
their dedicated
efforts to launch
this project!
VAP: Maintaining Zero
Trinity Regional Health System
Infection Prevention and Control
Presented by Patricia Herath, BSN, RNC
Infection Preventionist
April 20, 2010
Ventilator Associate Pneumonia –
(VAP) History


In first 9
months of 2006
– 13 VAPs
Developed
ventilator
bundle
Cost of VAPs to TRHS

Average cost of VAP:
$33,887*

13 VAPs in 2006 =
$440,531


Cost of product for
oral care: $30.30 for
24 hours
Avoiding VAP saves
$$$
Aim


Launched facilitywide initiative to
reduce VAPs
Zero rate was
targeted using IHI
VAP bundle
Action Plan


Formulated multidisciplinary team to
reduce VAP: Unit mgr, RN staff, RT, MD
champion
Initiated VAP bundle






Meticulous hand hygiene
HOB 30-45 degrees unless contraindicated
Peptic ulcer prophylaxis
Daily readiness to extubate
Oral care q 2H and prn (with product at head
of the bed) and deep suctioning q 8H
Also: anti embolism stockings and DVT
prophylaxis (e.g. meds, TEDS stockings)
Action Plan (cont.)

Issues identified:

Received commitment from staff to
provide:


oral care every 2 hours
competency education




in-services on protocol and rationale
target audience: physicians and nursing staff
Documentation of compliance to bundle
on check list
Identified need to improve charting
Results

Since October, 2006 Trinity Regional
Health System has had two VAPs

Currently 26 months without a VAP

2009 – 2010: rate = 0
Staff response: great “buy in” when positive
results noted
 Received resistance due to cost of product
used for oral care


Any suspected cases are reviewed in real
time
Huddles with Managers and unit staff
 Charts reviewed with Infectious Disease
physician

Results of increasing HH compliance
and HAI outcomes
5.0
100%
4.5
90%
4.0
80%
3.5
70%
3.0
60%
2.5
50%
2.0
40%
1.5
30%
1.0
20%
0.5
10%
0.0
0%
8
9
8
9
8
9
8
9
8
9
9
8
9
08
09
08
08 t- 08
09
09
08
08
09
09
-0
-0
l-0
l-0
v-0
v-0
t- 0
r- 0 ay-0
r- 0 ay-0
c-0 anc-0
nnnbbgpgpar
ar
Ju
Ju
Ja
Ap
Ju
Oc
No
J
Ap
Ju
Oc
No
Fe
M
Fe
M
Au
Se
De
Au
Se
De
M
M
Rate of HAI per 1000 pt days
HH Compliance
Hand Hygiene
Compliance
Rate of HAI
Rates of Healthcare Associated Infections at TRHS
Compared to Hand Hygiene Compliance
Acknowledgements
A
special thanks
is extended to
the VAP team for
their dedication
to launch and
maintain this
project!
Resources

Institute for Healthcare Improvements
(IHI) Improvement Project



IHI is a reliable source of energy, knowledge,
and support for a never-ending campaign to
improve health care worldwide. The
Institute helps accelerate change in health care
by cultivating promising concepts for improving
patient care and turning those ideas into
action.
CDC. www.cdc.org
Scott II, R.D. (March 2009). The direct
medical costs of healthcare-associated
infections in U.S. hospitals and the
benefits of prevention. Retrieved from
http://www.cdc.gov/ncidod/dhqp/pdf/Sco
tt_CostPaper.pdf (2010)