National Patient Safety Awareness Week

The IHI Central Line were introduced through initial educational presentations and posters. These bundles are a group of best practices that when applied together result in substantially lower the incidence of CLBSI. In November of 2007, we established a multidisciplinary team to perform daily grand rounds on all ICU patients with each. The team consisted of the Intensivist, the PA/NP, the ICU Director or alternate, Respiratory Therapy, Pharmacy, Dietary, Case Manager, Q Life and Infection Prevention. One of the primary foci of this team was the prevention of device infections through consistent application of the bundles, and to achieve this, ICU order sets were revised to include the bundle elements and reinforce their application.

Linda Odnoha
LMHS Gulf Coast Hospital
Director
ICU
FL

National Patient Safety Awareness Week

We are participating in the FHA collaborative, to reduce CLABSI, by refocusing on what we do great and expanding it to all areas of the bundle that has been proven to reduce and eliminate CLABSI. All critical care staff at both facilities signed a committment to patient safety contract, and went through several hours of training and education designed to promote great care all of the time. Staff have a heightened sense of awareness regarding line insertion and maintenance that is reflected in reduced CLABSI. More great news to follow.

Jonathan Kling
NCH Healthcare System
Director
Critical Care
FL

National Patient Safety Awareness Week

We have participated in the national calls and FHA calls. We had many of the tools in place before being part of the FHA Bsi Cusp project. We have all staff view the Josie and Safety/culture video and do the Culture tool. We also had active participation by all staff in the Safety video by discussion after viewing.Our hospital in November went to alcohol impregnated caps on central lines being placed in the ICUS and our IR department director is part of our team. The entire hospital is now getting on board with use of the alcohol impregnated caps for central lines on the floor. Our senior leadership, quality director and CNO are very active and we monitor central line opportunites real times with the guidance of our Infection Control team and Medical Director.The calls are always great and we learn from them, and bring back additional tools for providing safe, quality care to our patients.

Terrie Wood
Baptist Hospital
Surgical/Coronary Intensive Care Units
Director of Critical Care Services
FL

National Patient Safety Awareness Week

We started our journey almost 5 years ago, initiating the central line bundle in our ICU. We put together a "procedure cart" to have all items available to increase compliance. Nurses here were not initially comfortable with acting as the CL police, but they quickly embraced the challenge. We average about 200 CL catheter days per month (1200/yr) and longest we have gone without a CLABSI was 17 months. Currently we can't seem to get past a 7 month stretch, but we keep working at it!

Annette Forlenza
Cape Coral Hosptial
Director
ICU
FL

National Patient Safety Awareness Week

The staff at Monroe Carell Jr. Childrens Hospital at Vanderbilt are striving to eliminate CLABSI in the Neonatal Intensive Care Unit. The initiative started with the creation of a central line change toolkit and change in protocol. The staff in the NICU use a sterile tubing line change kit that includes chlorhexidine pads, alcohol pads, gauze and a drape/towel. Staff members add sterile connectors and other items needed for the central line. This items are placed on a clean table(set aside for line change only). One nurse will be assigned the "clean" nurse and the other will be the "sterile" nurse. Both nurses wear masks before beginning the line change. The clean nurse primes the fluids while the sterile nurse prepares the sterile field. The clean nurse attaches the tubing to the sterile connector and attaches the extra flushes to the connectors while the sterile nurse holds the connector. The clean nurse then cleans the central line site and the sterile nurse connects the connector to the central line site. Another initiative in the NICU is our handwashing policy. Upon entering a room (most patients have private rooms), everyone must wash/foam hands. Scrub up to elbows, removing jewelry. Another process to eliminate CLABSI, is that anyone that enters a room where a sterile line procedure is taking place must wear a mask and if that person is in the area of the sterile field, the person must also wear gown and hat in addition to the mask. All of these efforts have showed an improvement in VCH NICU CLABSI rates. Reports starting 1/13/2009 show 2 days between infection. The best rate we had to date is 87 days between infections. Our current rate is 77 days.

Christina Hillin, RN
Monroe Carell Childrens Hospital at Vanderbilt
NICU
TN

National Patient Safety Awareness Week

While I am not able to tell you a rate for NorthCrest's CLABSI prior to the initiative, I can say in the last three years (since we started using the Central Line Bundle and checklist) we have had only one CLABSI. This was from a femoral line started in the emergency department. We performed a thorough review of the breakdown in this individual's care and now have all our Emergency docs on board with avoiding femoral lines and adhering to our bundle and checklist. We took this very seriously and learned from our mistake.


Melissa Allen, RN, BSN, MS
Housewide ICP
NorthCrest Medical Center
TN

National Patient Safety Awareness Week

Like most acute care hospitals, Saint Francis Hospital Bartlett struggled with central line blood stream infections. In July 2008, we completed the first phase towards a focused reduction program in the intensive care unit. This unit was selected as the pilot area because it offered a consistent group of physicians and nurses maintaining those lines. During the months of January and February we evaluated our insertion kit, the number of steps and time it took to gather the appropriate materials, our culture of communication between physicians and staff, and the use of safety checklists. It was necessary to gather the preliminary information in order to determine the areas in the process that offered the greatest opportunity for improvement. Each change was preceded by staff education which encompassed the purpose of the change, supporting evidence for the change and instruction on how it would be monitored for effectiveness. We developed an all inclusive kit consistent with evidence based bundles as well as adding a time out checklist and providing a new central line procedure cart to stop the running back and forth for supplies. The most beneficial change came when we brought infection control to the bedside for monitoring and teaching. Once a week infection control rounds evaluated each patient’s risk for infection.Prior to completing all our changes, we recorded three central line blood stream infections between January 1, 2008 and June 30, 2008. After implement the changes, we had ZERO central line blood stream infections. The changes worked well until December 2008, at which time we encountered a total of three central line blood stream infections. We believed this was an isolated incident, however 2009 brought about more disappointment in our performance. In 2009 we encountered one to two infections per month for a total of 11 central line blood stream infections for the year. We continued with our established practices and conducted mini root cause analysis of every infection. During this process numerous external and cultural factors were reviewed for trends, and opportunities of improvement were identified. Our findings were discussed with both bedside staff and administrative team. In October 2009 we initiated the “clinical huddle”. This is a daily multidisciplinary reporting meeting to review every patient in house. Although time consuming it has proven effective in reducing our length of stay and infection rates. The year end summary data shows the placement of 364 central lines, with 3114 device days and an infection rate of 3.53 per 1000 patient days. So far, 2010 has shown a total of 82 central lines placed, 420 central line days and ZERO infections. Our plan is to maintain our established practices, while continuing our evaluations and identifying opportunities for improvement.

Karen Smith
Director of Clinical Quality
Saint Francis Hospital - Bartlett
TN