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Using the Model for Improvement to Reduce Line Related Infections in an Adult Renal Unit

Using the Model for Improvement to Reduce Line Related Infections in an Adult Renal Unit.

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Using the Model for Improvement to Reduce Line Related Infections in an Adult Renal Unit

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  1. Using the Model for Improvement to Reduce Line Related Infections in an Adult Renal Unit Patients with acute and chronic renal failure frequently develop hospital acquired infections. Baseline data showed a mean 3.1 days between bacteraemias which required treatment, and 21.7 days between S Aureus Bacteraemias (SABs), the majority from long term and temporary central venous dialysis catheters (CVC). Use of CVC care bundles reduce infection rate in intensive care1. Use of antimicrobial lock (AL) solutions may reduce infections in long term dialysis CVCs2, supported by some local data. Aim: To reduce the frequency of CVC related infections to greater than 300 days between infections in an adult renal unit by August 2013. Method Results A multi professional quality improvement team was formed. Baseline infection data were used to form hypotheses for potential interventions. These were tested using PDSA cycles. Process compliance data were gathered by staff not involved with the processes, using random sampling methods, and analysed using statistical process control charts. Non SAB infections decreased from 3.4 days between infections to 41.3 days. Segmentation of patients’ by vascular access (long term vs. temporary CVC) suggest both ALs and CVC bundles have a beneficial effect (charts not shown here).SAB rates were unchanged, but arose from many sources including CVCs. It is too early to measure an effect on CVC related SABs. We hypothesised that the process of connection and disconnection from haemodialysis affected SAB risk, and are testing the effect of process reliability. Conclusions Reliableprocesses reduce CVC related infection in patients with renal disease. Reduction in infection rate, data analysis and team learning allows testing of other key processes affecting outcome. Process change Compliance with line bundles improved with the use of checklist stickers for insertion, and a prompt to use a checklist on the medicines kardex for CVC maintenance. Measurement showed that use of the correct AL was universal at first introduction as it was a prescribed medication. Further information Name: Sanjiv Chohan Title:Consultant ICU and Anaesthetics Board: Monklands Hospital, NHS Lanarkshire Contact Details:sanjiv.chohan@nhs.net -Insert Photo-

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