ON THE CUSP: STOP BSI

National Patient Safety Awareness Week

2010-03-12T07:19:00.000-08:00

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

2010-03-12T07:18:00.000-08:00

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

2010-03-12T07:17:00.002-08:00

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

2010-03-12T07:17:00.001-08:00

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

2010-03-10T09:20:00.000-08:00

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

2010-03-10T09:19:00.000-08:00

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

2010-03-10T09:18:00.000-08:00

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

Dr. Pronovost's on CNN's House Call this Saturday and Sunday @ 7:30am.

2010-03-05T14:22:00.000-08:00

Please tune into CNN House Call Sanjay Gupta, MD to see Dr. Pronovost's interview this Saturday and Sunday @ 7:30am.

http://www.cnn.com/CNN/Programs/house.call/

Checklist for National Patient Safety Awareness Week

2010-03-05T14:02:00.000-08:00

1. Meet with your improvement team, review your CLABSI rates, commit that preventable harm is untenable, and ensure all staff watch the science of safety video.

2. Ensure your unit has a central line cart that has all the supplies needed to comply with the central line insertion checklist and ensure someone is assigned to stock the cart

3. Empower nurses to ensure physicians comply with the checklist while inserting catheters.

4. Investigate every CLABSI. If the infection occurs within 5 days of insertion, the defect is likely with insertion so find out where the line was inserted. If the infection occurs greater than 5 days after insertion, the problem is likely with maintenance so review your catheter maintenance.

5. Consider using bio patch.

National Patient Safety Awareness Week

2010-03-05T13:31:00.005-08:00

We are currently 335 days without a CLBSI. We owe this this to the professional collaboration between physicians and nursing and ongoing education on CLBSI evidence based practice.

Stacey Warner, RN

ICU

St. Mary's Hospital @ Amsterdam

National Patient Safety Awareness Week

2010-03-05T13:31:00.003-08:00

We started our program in 2004 after publication of Dr provonosts artcile introducing the checklist for insertion of CVCs. We quickly broadened our survielence to include PICCS as we were able top decrease our CLABSI rate for CVCs by switching them out ofr pICCS early in the pts course. We had zero cvc infections but PICC infections were still occurring. Soon most of the PICC line infections were pts who never were in the ICU and were occurring more then 1-2 weeks after insertion. The 2 interventions we started with STOP_BSI were getting the floor nurses to start questioning why lines were being left in when not being used and use of the biopatch. Last year we reduced our Clabsi rate from 6 to 2 for a rate of 0.57 with gretaer then 3500 cath days

Blaise Latriano

Medical Director

ICU

Warren Hospital

National Patient Safety Awareness Week

2010-03-05T13:31:00.001-08:00

At Seton Health where I am Nurse Manager we have had a total of 1446 line days from Jan.2009 through Jan.2010 There have been a total of two central line infections with in this time frame but, we have not had a central line infection in the past eight months. I as nurse manger lead our team. There is a sub committee for the prevention of catheter related blood stream infections. This consists of critical care staff members. They mentor fellow coworkers on prevention and also they have branched out through other units within the facility to educate nurse on prevention of BSI. I as manager do daily rounds at least twice daily checking for line necessity and dressing. I review this with staff when rounding. Central line need and use is also discussed daily with the pulmonologists. At 10am is our daily rounds with the intradiciplinary team. All invasive lines are reviewed with the infection control nurse. She is immediately notified of any new invasive line. A insertion check list is done when ever a line is inserted. A record is kept in a binder for reference kept on the unit. A copy is give to the infection prevention nurse. She callculates our central line days and determines are infection rate. Research is done for current evidenced based practice to further protect our patient from harm.Data collected for central line infections and bundel compliance is presented to leadership through our clinical excellence committee. In adition to compling with the bundel elements a site rite is used for insertion, pressureized ports are used and we have disconntinued the use of heparin for flushes. We have implemented the use of effectiv cap for needless valves. these caps are saturated with alcohol and placed on all unused ports. We are constantly doing research and education and we are very happy to be a part of this project.

Mary Anne Clow

Nurse Manager

Critical Care

Seton Health Hospital St.Mary's

National Patient Safety Awareness Week

2010-03-05T13:30:00.002-08:00

Here at Fauquier Hospital we make sure that every line is inserted under sterile tchnique. We use a drap that covers the entire patient from head to toe. Everyone in the room wears a mask. We assess daily the removal of a central line. If a femoral line is placed we remove in 24 hours. We use biopatch with every dressing change and every central line dressing is changed every wednesday. We clean the site with chlorohexadine. Dressing changes are done with a mask on the face.

Shawna Racey, RN

Clinical Coordinator

Intensive Care Unit

Fauquier Health

National Patient Safety Awareness Week

2010-03-05T13:30:00.001-08:00

At Shenandoah Memorial Hospital in Woodstock, Virginia we identified a need based on infection control reporting of central line infections hospital wide. We developed a committee to review all research on best practices for preventing central line infections. We had a physician, nurses from each unit, infection control nurse, and performance improvement on the committee. A checklist was developed to send to infection control to assure compliance with all recommended practices for inserting central lines. At SMH, we start with a timeout form, physician and nurse assistant both wear gowns, masks, and gloves. Pt. is covered with a full body drape and sterile technique is maintained during the entire procedure. We mark on the checklist whether all of these guidelines were followed. Central line dressing is changed every 48 hours using a central line dressing kit. For the 2009 we had 0 central line site infections.

Robin Scruggs, RN

Charge Nurse

Intensive Care Unit

Shenandoah Memorial Hospital

National Patient Safety Awareness Week

2010-03-05T13:24:00.000-08:00

We achieved a 51% reduction in our facility wide, mean CLABSI rate in 2009 compared with calendar year 2008. Our CLABSI rate in 2007 was 4.6. Unfortunately, our rate increased in 2008 to 5.5, partly due to a transition to a valve system for accessing IV lines. In 2009, we had 53, 323 line days and 144 CLABSI events, 101 less than the year before, and a mean rate of 2.7.Our journey began in 2006/2007 with implementation of a central line insertion bundle, development of a policy to support the implementation and empowerment of nurses to monitor and stop line insertion procedures. We also began auditing compliance with the bundle and providing feedback to physicians, management, and staff.In February 2008, we transitioned to the Smart Site valve and began seeing an increase in CLABSI rates within a month. With repeated educational efforts, the CLABSI rates did not decrease. In September 2008, we formed a Zero BSI team to address the increasing rates. Four pilot inpatient units and Ambulatory Care participated. Our goal was to achieve rates of zero in all four units by April 2009. Our team focused on development of an IV line care and maintenance bundle and very specific BSI prevention educational modules for all staff that touch IV lines. The educational modules were completed by pilot unit staff and have become part of clinical orientation as well as being required of current staff. We surveyed staff prior to and after education, audited IV line care and access practices and developed a Clinical Scene Investigation tool for the investigation of BSI events. By April 2009, there was only one CLABSI in the four pilot units. We then rolled out the new bundle and the educational modules housewide. Also, reduction of CLABSI rates is a leadership evaluation goal for appropriate management staff. We improved feedback and transparency of individual unit rates. In late 2009, we joined the Stop BSI initiative and have 16 units enrolled in teams. Departments, such as Anesthesia, Pharmacy, the Emergency Departments, Interventional Radiology, are represented on our teams. Teams are developing daily goals checklists, monitoring compliance with the line insertion bundle, sharing The Science of Safety and Josie King Story videos with staff. Not only are individual teams meeting, we also meet once a month as a group with representatives from each team. We have calculated CLABSI events prevented and calculated excess days and costs prevented and lives saved and have shared this information throughout the facility. We continue to stress our goal of zero CLABSI. Dr. Pronovost, if you are reading this, we wish to have you and Dr. Miller visit the Medical University of South Carolina. Dr. Michelle Hudspeth with our Children’s Hospital has communicated with Marlene and I have been in touch with Christine. Please come help us drive our rates to zero.

Linda Formby

Manager, Infection Prevention and Control

Medical University of South Carolina

Decreasing PICU Catheter-Associated Bloodstream Infections: NACHRI's Quality Transformation Efforts

2010-01-13T07:15:00.001-08:00

Here is another example of what is possible, virtually eliminating BSI in pediatric ICUs. This intervention highlights the importance of focusing on catheter maintenance and the need for valid data. We can eliminate these infections and at the end of the day we need data to know if we did.

Download: Decreasing PICU Catheter-Associated Bloodstream Infections: NACHRI's Quality Transformation Efforts

-Peter

Culture change is critical

2009-11-13T16:45:00.000-08:00

Many hospitals say they are using the checklist yet their rates of CLABSI remain high. When I ask whether a nurse in their hospital would stop a senior physician who violated one of the items on the checklist, the answer is nearly always "NO". This is why culture change is so critical to our work and why we are asking you to do CUSP. However, some of you have successfully changed culture so that nurses can and do ensure patients receive the checklist items even if a doctor forgets. Your colleagues in other hospitals and states would love to hear how you created a culture that allows nurses to question physicians or what you are struggeling with in trying to change culture. Please add your thoughts and comments in response to this post.

Thank you,

Peter

Engaging Physicians

2009-09-29T11:46:00.000-07:00

We recognize that if this project is to be successful, we must engage physicians. We also recognize that this is often very difficult. To help with this, on our website, we provide training on engaging physicians.

What are you doing that seems to be effective in engaging physicians in this work?

Please share your successes and struggles.

Peter

Welcome Message From Dr. Peter Pronovost

2009-09-25T12:33:00.000-07:00

On the CUSP Stop BSI is a groundbreaking national program to improve patient safety. It is our Polio campaign of the 21st century. With efforts, with more volunteers than any standing army in history, the word has virtually eliminated polio. We now need to do the same for central line associated blood stream infections.

Many of us have led large scale collaborative projects, but no one has ever done a data rich national project that offers hope of improving the culture of safety in hospitals and measurably improving infection rates. It will not be easy, no one has done this before; yet with 30,000 to 62,000 dying from these infections a year in the U.S, we have no choice, we have to succeed. It will require the leadership of all of you.

I am eager to learn with you, to reduce infections and improve culture, and to build capacity to tackle the next problem. Our team is excited about participating in this historic project and the potential this holds as a method for reducing infections, and improving the often toxic culture of medicine. I am curious, what excites YOU about participating in this project?

Warmly,

Peter