1 / 20

Effectiveness of Central Line Bundles in Prevention of Catheter Related Infections Arthur Price The Pennsylvania State

Effectiveness of Central Line Bundles in Prevention of Catheter Related Infections Arthur Price The Pennsylvania State University. Key Words Defined.

stew
Download Presentation

Effectiveness of Central Line Bundles in Prevention of Catheter Related Infections Arthur Price The Pennsylvania State

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Effectiveness of Central Line Bundles in Prevention of Catheter Related InfectionsArthur PriceThe Pennsylvania State University

  2. Key Words Defined Central Line: A vascular access device inserted into the vena cava in order to facilitate intravenous access.Central Line bundle: Procedure involving meticulous hand hygiene before contact with central line, using maximal sterile barriers during insertion, using Chlorhexadine 2% solution for catheter and skin asepsis, optimal site placement(avoidance of femoral, jugular veins), daily assessment for continued need.CRI’s: Infection resulting from central line placementImplementation strategies: Inclusive of Central Line insertion supply carts, education, and nurse empowerment to cease or interrupt procedure if aseptic integrity is impaired

  3. Introduction • Central Line are an essential part of the care or critically ill patients • Required for caustic medications, poor and long term venous access, and hemodynamic monitoring. • Carries substantial risk factors for infection bypass natural barrier and defenses

  4. Signifigance • Estimated that 50% OF ICU patient need CVC, 35% become infected(Hadaway. 2006) • Estimated mortality 3200-50000(Hadaway. 2006) and 24000 (Perencevich, & Pittet, 2009 )lives annually making CRI’s leading cause of nosocomial deaths. • Average increase length of stay of 12 days at a cost of $18000 per infection(Perencevich, & Pittet, 2009) • Total national cost of health care dollars is estimated at $3.6 billon dollars(Galpern, Guerrero, Tu, Fahoum , & Wise, 2008)

  5. Listed as a “never” complications • Research concluded most CRI’s are preventable(Goede, & Coopersmith, 2009). • Most states have reporting requirement compelling facilities to report CRI’s decreasing quality ratings. • Medicare began an initiative to deny reimbursement for treatment of CRI’s. private insurance is expected to follow suit.

  6. Focused Problem In P.I.C.O format In acutely ill hospitalized patients that require a central venous line(population), managed with a Central Line Bundle(intervention), will contract less Catheter related Infections(outcome). Then patients managed with a singular or no property of the Central Line Bundle(comparison).

  7. Methodology • Databases Searched: CINAL, Cochrane, Google Scholar, and PUB MED. • Keywords: Central Line, central line infection, central line associated bloodstream infection, prevention, nursing research, & central line bundle. • Limitations: Adults, not pediatrics, or neonatal, 1996-2010 only, include clinical studies, meta-analysis, journal articles, systemic reviews. • 4 articles were selected for review.

  8. Elimination of Central Line-Associated Bloodstream InfectionPosa et al (2006) • Trial conducted at 2 hospitals in Michigan(Evidence Level 2a) • Used the Central Line Bundle, Central Line Supply Cart, Check List, Nurse empowerment, and through education program • Resulted in 60% reduction in CRI’s over 2 years • Explained a drill down analysis procedure to out root breaks in bundle systems • Limitations: non randomized no variability analysis of bundle or implementation strategies

  9. 6 year study at John Hopkins ICU(Evidence Level 3) • Focused on increasing staff knowledge and insight into CRI’s, used supply carts, and nurse empowerment. • Stated a 94% decrease in CRI’s from 1998 to 2004 • Limitations not randomized, multiple changes in equipment during the period, limited to 1 hospital’s ICU, no variability analysis Best-practice protocols: preventing central line infection. Nursing ManagementEarsing et al.

  10. Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit • Galpern et al. (2008) • 2 year study in New York City, NY. Methodist Hospital(Evidence Level 2a) • Focused on using central line bundle with active nurse involvement and, central line cart. • Stated 82% decrease in CRI’s (p<0.001) • Limitations: Limited to only one hospital, non descriptive of in-service education, no variability analysis of bundle interventions, implementation strategies

  11. 2 phase quasi-experiment in san Paulo Brazil ICU and SDU(Evidence Level 2b) • Phase 1 (2 years) instituted bundle intervention without requiring nurse involvement, site selection, daily review or supply cart • Phase 2 (two years) required checklist, nurse presence, quality assurance, site placement, independent review for continued need. • Results between 2 phases showed 39% in SDU and 50% decrease in Medical ICU’s(P>0.001) • Limitations: non randomized, compliance data not complete, no description of staff education, or experience Impact of a Program to Prevent Central Line-Associated Bloodstream infection in the Zero Tolerance Era. Marra et al.(2010)

  12. Recommendations of Literature • Nurse empowerment regarding involvement in insertion, and quality assurance is essential • Requirement of an education programs geared to train nurses on the bundle intervention’s and significance of its use • Assembly of supply carts for insertion readily available. • Compliance and infection surveillance

  13. Intervention • 2 series of education programs one for those identified as “experts”, and 1 for lesser experienced nurses; overall goal to in-service all RN’s and have precepted competency in insertion assistance. • Assemble supply carts • Create quality assurance checklist, daily need charting, and reporting systems. • Consult physicians to avoid jugular, femoral sites. • Monitor unit and organizational level for compliance and CRI’s

  14. Frame work • Patricia Benner’s Novice to Expert theory • Allows for awareness of individual nurses learning needs in there respective growth stations • Recognizes experience and critical thinking acquisition plays in effective training. • Theory opens the doors to education replication by mentors to possibly decrease need for repetitive education

  15. Outcome Evaluation • Control group is not ethical • Will compare to CRI rates retroactive to January 2010, local, state, and national benchmarks. • Monthly evaluation reports will be completed • Tool of measurement CRI divided by total catheter use days times 1000. as per CDC and JCAHO recommendations.

  16. Risks • Increase CRI rate • Unsubstantial decrease in CRI’s • Administrative and physician resistance • Difficulty in education and individual compliance Benefits • Decrease in patient stays and mortality, lessen risk of no compensation, greater hospital quality rating

  17. Summary • Central Lines present lethal and costly risk • Central line bundles intervention coupled with implementation strategies have proven effective in decreasing CRI’s. • Intervention: assembly ofaccessible supply carts, empower nurses, education in CRI awareness and avoidance will decrease CRI incidents.

  18. References • Earsing, K, Hobson, D, & White, k. (2005). Best-practice protocols: preventing central line infection. Nursing Management, 36(10), Retrieved from http://www.nursingcenter.com/pdf.asp?AID=605304 • Galpern, D, Guerrero, A, Tu, A, Fahoum, B, & Wise, L. (2008). Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit. Surgery.144(4), Retrieved from http://www.ncbi.nlm.nih.gov.ezaccess.libraries.psu.edu/pubmed/18847630 • Goede, M, & Coopersmith, C. (2009). Catheter-bloodstream infection. World Journal of Surgery, 23(6), Retrieved from http://www.springerlink.comdoi: 10.1016/j.suc.2008.09.003 • Hadaway, Lynn. (2006). Keeping central line infection at bay. Nursing 2006, 36(4), 48-63. • Marra, A. Cal, R, Durao, M, Correa, L,Guastelli, L, Moura, D, Edmond, M, & Santos, F. (2010). Impact of a Program to Prevent Central Line-Associated Bloodstream infection in the Zero Tolerance Era. American Journal of Infection Control, 36(6), Retrieved from http://www.sciencedirect.com/ • Perencevich, E, & Pittet, D. (2009). Preventing Catheter-related, Bloodstream Infections. JAMA, 301(12), 1287-1285 • Posa, P, Harrison, D, & Vollman, K. (2006). Elimination of Central Line-Associated Bloodstream Infection. AACN Advanced Critical Care, 17(4), 446-454. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17091045

  19. QUESTIONS?

More Related