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
1
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
• New product review
• IV team report
• 2013 transitioned to IP Task Force
Ellis Hospital Infection Prevention CLABSI Worksheet
Patient Name:
Age:
Admit-d/c Date:
Dx:
MR#
Readmit Date:
Inf. Date:
Unit:
Bed Transfer Hx:
Abx. Tx:
#Cath. Days to Inf:
CLABSI Criteria:
Bld. Cx. (Date/Organism) #1
Bld. Cx. (Date/Organism) #2
S&S:
Chills
Fever (>38C)
Hypotension
Central Line (s):
CL #1 Type/Site
Emerg.
Yes
Insert Date
No
Removal Date
CL #2 Type/Site
Emerg.
Yes
Inserter
Tip Cx.
Insert Date
No
Inserter
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?
Was the exit site clear?
Yes
Was the Biopatch in place?
No
Yes
Yes
Yes
No
Comments:
No
Describe any site issues:
No
Were cap & dressing changes documented every 7 days?
Yes
No
Describe any dressing issues:
Was the patient on TPN?
Yes
No
Was the patient in Hemodialysis?
Yes
No
Date of last dialysis before onset of infection:
Date Case Reviewed:
Findings:
Insert Loc.
Comments:
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
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
12/3 – 12/5
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
ICU CLABSI RATES 2007-2013
Ag
coate
3.4
d TLC
3.2
CHG for
insertion
3
2.8
Standardize
Insertion
2.6
Daily
rounding
2.4
2.2
2
1.8
1.6
CL
insertion
checklist
CHG
bathing
1.4
Curos
1.2
1
0.8
0.6
Ag
V link
0.4
High Five
campaign
0.2
0
2007
2008
2009
2010
Q1
2011
Q2
2011
Q3
2011
Q4
2011
Q1
2012
Q2
2012
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!