Central Line Blood Stream Infections

1. Central LineBlood Stream Infections Houston Medical Center Tomeko Fuller, RN, BSN Clinical Resource Manager

2. Points of Discussion • Goals • Objectives • History • Problem • Methodology • Implementation • New Process • Outcome

3. Goals • Ultimate Goal - Zero Central Line Blood Stream Infections • Goal for 2012 – To have 25% reduction in Blood Stream Infections at Houston Medical Center.

4. Objectives • To create a cost effective process to reduce Blood stream infections utilizing resources available with our Central Line Dressing changes.

5. Problem • During rounds it was noted that Central Line dressings were not being changed per our policy. Some dressing were not changed correctly or in the time frame set. • No accountability for who was responsible for the dressing change. Day or Nightshift nurse • No consistency • Recommendation was made to decrease the number of staff members responsible for dressing changes.

6. Methodology • A new process was discussed with the Infection Prevention & Control Manager, Director of Nursing and IV Therapy Manager to utilize IV Therapy nurses . • Implementing a cost-effective process. • A process focused on ensuring efficient use of time by all staff.

7. Implementation • Discussed process with the Med/Surg, ICU and IV Therapy Nurse Managers and Clinical Coordinators in a meeting. • Arranged a Trial Period June 6 -27, 2012. • Discussed With IV therapy nurses the process and expectations. • Educated IV Therapy nurses on the documentation in Meditech. • Contacted IT department to give nurse permission to access patient information. • Arranged for supply availability to complete dressing changes • Definined a way to accurately capture supply charges.

8. New Process • ROUTINE central line dressings will be changed on WEDNESDAY by IVT nurse. • The ANM or charge nurse for each Med/Surg area will FAX a list of the patients that have a central line to IV Therapy on Tuesday evening or early (before 0800) Wednesday morning. • Supplies for the dressing change will be brought from IV Therapy and restocked on the Nursing unit. • PICC = PICC dressing tray, biopatch, 1 end cap for each lumen, saline flush • Central line = Central line dressing tray, 1 end cap for each lumen, saline flush • Port= Huber needle, Central line dressing tray, 1 end cap, saline flush • IVT nurse will change the dressing, communicate with the primary nurse and/or charge nurse and document the procedure in the patient’s record. • The IVT Manager will keep the Med/Surg Managers and Infection Prevention & Control Manager informed of findings each week during the trial

9. Trial Phase • June 6, 2012 • A total of 13 dressings changed • 2 Main= 5 (2 PICC, 1 IJ, 1 femoral line, 1 Port) • 3 Main = 3 (2 ports, 1 PICC) • 4 Main = 1(sutured PICC) • 2 N= 2(1 PICC and 1 IJ) • 5 NW= 2(1 port, 1 PICC) • The IVT nurses reported that it went very well, all the staff was appreciative and helped with making sure supply charges were completed appropriately. • Remember…IVT will bring supplies to the room with them and restock from your supply room. This insures that the patient gets charged appropriately and that no supplies are wasted. • June 13, 2012 • Total of 9 dressings changed • 2 Main = 4 (1 port, 3 PICCs) • 3 Main = 3 (1 port, 1 PICC and 1 Central line-double lumen) • 4 M= 0 • 2 N= 0 • 5NW= 2 (2 PICCs) • No problems reported. • Remember we will restock from YOUR supplies

10. Trial Phase • June 20, 2012 • Total of 21 dressings changed • 2 Main = 8 (1Trauma cath, 7 PICCs) • 3 Main = 7 (2 ports, 5 PICCs) • 4 M= 2(1 port, 1 PICC) • 2 N= 1 (port) • 5NW= 3 (2 PICCs, 1 port) • No problems reported. • June 27, 2012 • Total of 14 dressings changed • 2 Main = 7 (1 triple lumen central line, 3 PICCs, 3ports) • 3 Main = 2 (1 port, 1 PICC) • 4 M= 0 • 2 N= 2 (1port, 1 PICC) • 5NW= 3 (2 PICCs, 1 port) • No problem reported

11. Outcomes • Per our Infection Prevention & Control Department we have NOT had any reportable Central Line Blood Stream Infections since July 1, 2012

12. Outcomes 1

13. Outcomes 2 Baseline CLABSI data: 47% Reduction House wide; 50% Reduction ICU 2008-2011 • 2008: 15 cases house wide, 6 ICU cases • 2009: 13 cases house wide, 3 ICU cases • 2010: 10 cases house wide, 2 ICU cases • 2011: 8 cases house wide, 3 ICU cases • 2012: (YTD) 5 cases house wide, 1 ICU case

14. Team Members 1 Team Members • Melinda Hartley, DNP, RN, NE-BC, VP Patient Care Services/CNO • Laura Gentry, RN, BSN, Director of Nursing • Tomeko Fuller, RN, BSN, Clinical Resource Manager • Barbara Adkins, RN, Nurse Manager Cardiac/ Telemetry Services • Tim Bennett Infection Prevention & Control Manager • Karen Bowen Infection Prevention & Control Assistant