Beyond the Bundle: To Patch or Not To Patch
Angela Skelton RN, BSN, CRNI
United Regional, Wichita Falls, TX
Abstract
For several years the focus has been on
preventing CLABSI related to improved
insertion practices and following an evidencebased insertion bundle. We then realized we
needed to focus on care and maintenance of
our lines and evaluate our current practices
against evidence based practices. In evaluating
the need for an anti-microbial patch for our
institution we recognized an opportunity to
improve patient outcomes and improve the
efficiency of our vascular access team by
utilizing an antimicrobial dressing.
Objective
• Eliminate the existing practice of a 2 day
dressing change post PICC insertion.
• Evaluate the financial impact of adding an
antimicrobial dressing.
• Reduce Central Line Associated Bloodstream
Infection (CLABSI)Rate from baseline of
0.24/1000 line days to zero.
•Identify and target microorganisms identified
for CLABSI for 2010.
United Regional 2010 Organisms
S. Aureus
K. Pneumoniae
S. Epidermidis
Methods
•Evaluate 4 antimicrobial dressings/ 100 lines
each for a total of 400 dressing applications.
•Develop tracking for each dressing and an
evaluation tool for users.
•Compare dressing change kits used per line
insertion pre trial and compare at 3 months and
6 months after product implementation.
•Report CLABSI rate on PICC lines with
antimicrobial in use.
Beyond the Bundle: To Patch or Not To Patch
Angela Skelton RN, BSN, CRNI
United Regional, Wichita Falls, TX
CLA-BSI Rate (2011)
House-wide – 0.22
Lines with GuardIVa - 0
Pre implementation cost prior to evaluation hemostatic patch for
dressing changes:
$63,012 (nursing time and supplies) annually
Post implementation to adding hemostatic patch for dressing
changes:
$48,824 (nursing times and supplies) annually
Overall savings for addition of hemostatic patch for dressing
changes was estimated at:
$14,188 annually
Conclusions
References
5 Million Live Campaign(2008). Getting started kit: Preventing central line
infections how-to-guide, Cambridge Massachusetts: Institute for
Healthcare Improvement; 2008. (available at. www.ihi.org)
Tools for Reducing Central Line Associated Blood Stream Infections (March
2013), Agency for Healthcare Research and Quality www.ahrq.gov
Infusion Nursing Society (2011) Infusion Nursing Standards of Practice
Journal of Infusion Nursing 34 (1S)
O’Grady NP et al (2011). CDC Guidelines for the Prevention of
Intravascular Catheter-Related Infections
•400 PICC line insertions and dressing changes were
evaluated and the infusion staff chose GuardIVa
based on their evaluation tool and overall
performance.
•Following GuardIVa implementation there were
positive results for improved patient quality with
Zero CLABSI on these vascular access devices.
GuardIVa also had a positive financial impact by
saving time and material utilization by saving
$14,188 annually compared to the previous practice
of a 2 day dressing change with sterile gauze placed
at the time of insertion.