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Preventing Central Line Infections

Preventing Central Line Infections. Saving 100,000 Lives with IHI Presented by Brenda Hackett, MT, CIC, MPH. The New Healthcare Mission 2006 & Beyond. IHI (& Others) Healthcare Campaign - Goal = Save 100,000 lives per year - Proven intervention “bundles” - Quick, Adaptive PDCA

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Preventing Central Line Infections

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  1. Preventing Central Line Infections Saving 100,000 Lives with IHI Presented by Brenda Hackett, MT, CIC, MPH

  2. The New Healthcare Mission2006 & Beyond • IHI (& Others) Healthcare Campaign - Goal = Save 100,000 lives per year - Proven intervention “bundles” - Quick, Adaptive PDCA - Measure and share success **www.ihi.org – info/materials

  3. What is the Goal ? • Prevent catheter-related bloodstream infections WHY? * 60-80% BSI caused by cvcs1 * 14,000-28,000 associated deaths/yr. * LOS mean of 7 d * Cost $3700-29,0002 1 Wisplinghoff et al. Clin Infect Dis 36:1103, 2003 2 Soufir et al. Infection Control Hosp Epi. 20(6) 1999

  4. The Central Line Bundle 5 Evidence Based Components * IHI CR-BSI bundle - *Shocking reductions in CR-BSI rates • Hand Hygiene • Maximal Barrier Precautions • Chlorhexidine skin antisepsis • Optimal catheter site selection -subclavian preferred for non-tunneled • Daily review line necessity -prompt removal if unnecessary

  5. Hand Hygiene • Hand hygiene for Central Line Care: - Before/after palpating insertion site - Before/after inserting, accessing, dressing an intravascular catheter - Suspect or obviously soiled hands - Between patients - Before donning/after removing gloves - After using restroom

  6. Maximal Barrier Precautions **Applies to Everyone involved in Line Insertion • Includes: -Hand Hygiene -Cap, Mask, Sterile gown, Gloves For Patient: -Large sterile drape – small opening insertion site * 2 Studies – Raad and Mermel et al. – CR-BSI reduced with maximal barriers

  7. Chlorhexidine antisepsis • Chlorhexidine antisepsis – prep central line insertion site *Studies support better skin antisepsis than other antiseptic agents (if not contraindicated) * Beware: patient safety- alcohol pooling + cautery = potential danger

  8. Optimal Catheter Site Selection • Many infections develop at insertion site • Subclavian Preferred Site • Recent study = site didn’t matter (*if controlled environment for insertion/care) *Other site OK if Documented rationale

  9. Daily Review Line Necessity-Prompt Removal • Remove Unnecessary lines • Increased time line in = Increased risk of infection

  10. Getting Started…?? PLAN *Gather Team – stakeholders • Define the Problem - Pilot one area? - spread the change • Develop Aim Statement -what, how, by when? • Plan data collection -baseline bundle compliance –insertion checklist -baseline CR-BSI infection rates - Definition Cr-BSI? - (NHSN: Central Line = tip terminates in a great vessel)

  11. Collect Baseline Compliance Data–(observation/questionnaire)

  12. Analyze Baseline Data

  13. Act • Develop “Plan of Attack” -Feedback baseline results -Get input – “current state” (what are we doing?/why?/obstacles to change) - Standardize -Develop/implement educational plan -Develop safety checklist - cvc insertion -Pilot safety checklist

  14. CVC Insertion Safety Checklist Ensure the Right Way - All the Time: • Educate Staff • Engineer for Safety -Reduce opportunity for error • Empower Staff

  15. CVC Safety Checklist - EXAMPLE Date: Reason For Insertion: Malfunction ___ New indication ____ Other ____ Insertion Site: Subclavian_____ Jug _____ Fem _____ Other_____ • Consent completed • Preparation Patient equipment • Patient Positioned • Time-Out (right patient/right site) Central Line Insertion Bundle • hand hygiene • full body barrier implemented • chlorhexidine prep (if not contraindicated) • catheter secured in place Post Procedure • Sterile/ appropriate dressing applied • Documentation insertion/exchange • Safety check for sharps/guide wire • M.D. order – Post procedure x-ray if appropriate • M.D. post procedure note

  16. Measure Trends • Trend Bundle Compliance • Trend CR-BSI Infection Rates -Share Feedback - Solicit input - Patient/Family Fact sheet – involve them - Share success

  17. The GOAL Compliance with CVC Bundle CR-BSI Rate per 1000 cvc days Intervention

  18. The GOAL *Measure # of Days Until Next Infection

  19. The GOAL • SAVE Patient Lives • Reduce Morbidity • Be Healthcare Customer of Choice • SAVE Healthcare $$

  20. THANK YOU! • Your Patients and their Families Thank You • Your Hospitals Thank You

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