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CLABSI Investigation

Learn from experienced nurses how to tackle high infection rates and prevent CLABSI risks effectively. Detailed process audit insights and actionable strategies provided.

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CLABSI Investigation

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  1. CLABSI Investigation Melinda Sawyer, RN, MSN, PCCN David A. Thompson DNSc, MS, RN

  2. Learning Objectives • Describe the steps to take if your unit’s infection rate is higher than zero • Describe the “lessons learned” from others who have walked this process

  3. Infection rate above zero? Or Were you at zero and then had a spike in your infections?

  4. Spike in Infections? We suggest walking the process from line placement to maintenance before adding new technologies.

  5. Process Auditing Patient Level -- • Was the checklist used? • Was the protocol followed? • Did everyone wear appropriate clothing? • Did someone speak up? • Was the dressing secured? • Was the site cleaned and maintained per protocol? • Did you use a preferred site for placement? • Did the line stay in longer than necessary?

  6. Process Audit: Lessons Learned • Attributable infection definition misunderstood • ICU taking credit for infections identified within 72 hours of being placed in the ED • ICU spread use of bundle to the ED • Checklist used but nurses documenting noncompliance instead of stopping procedure • Nurses must be empowered to stop the procedure • Nurses did not feel they had leadership support to stop the procedure • Leadership gave nurses a number to call if any problems encountered

  7. Process Audit: Lessons Learned • ICU was not asking daily if central line could be removed • Added question to Daily Goals worksheet • Inconsistent compliance with scrubbing hub prior to accessing line • “Scrub the Hub” campaign in unit • Vascular access team and Infection Control provided training to all staff who accessed lines

  8. Standardize

  9. Line Cart Contents – 4 drawers

  10. Process Auditing Unit Level: • % of time the IV administration set was replaced per policy? • % of femoral lines versus IJ and SC? • % of time the checklist is used? • % of time the protocol is followed? • % of lines that could have been removed? • % of nurses that are comfortable stopping procedure? Did they stop it when necessary? • % of lines that are changed after emergent placement?

  11. Process Audit: Lessons Learned IV Administration Set Replacement Pronovost, et al. Jt Comm J Qual Patient Saf. 2006

  12. Process Audit: Lessons Learned • One ICU’s central line infections associated with one particular provider • Identified providers given additional training • Individual providers more comfortable with femoral site over IJ or SC • Identified providers given additional training on IJ and SC insertions

  13. Process Audit: Lessons Learned • Charge RN found a dozen full-barrier drapes in a storage drawer • Identified ICU central line cart with ¾-length drape • Initiated routine training on cart equipment • Labeled cart with required equipment • ICUs and step downs each had central line cart, but providers on floors used a bundle that was not complete • Developed new bundle

  14. Infrequent Infections?

  15. Infrequent Infections • Consider each infection a defect worthy of a full analysis? • Use a comprehensive tool to help identify the system defect • Learning from Defects Tool • Develop a plan to prevent the system defect in the future

  16. Conclusion • Ensure your unit is implementing recommendations for central line maintenance • Identify your areas that need improvement • Develop a plan with your interdisciplinary team that includes Infection Control staff • Implement plan and watch for results • Consider adding new technology if little or no improvement but only after you are 100% compliant

  17. References • Marschall J, Mermel LA, Classen D, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infection Control and Hospital Epidemiology. 2008; 29 (supp. 1):S22-S30. • O’Grady NP, Alexander M, Dellinger P, et al. Guidelines for the prevention of intravascular catheter-related infections. Infection Control and Hospital Epidemiology. 2002; 23(12):759-769. • Pronovost PJ, King J, Holzmueller CG, et al. A web-based tool for the Comprehensive Unit-based Safety Program (CUSP). Jt Comm J Qual Patient Saf. 2006 Mar; 32(3):119-29. • Timsit JF, Schwebel C, Bouadma L, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: A randomized controlled trial. JAMA; 301(12): 1231-1241.

  18. Thank You

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