Working with the NC
Prevent CLABSI Collaborative, the Vascular Access Safety Team (V.A.S.T.) at
CaroMont Health in Gastonia has reduced Central Line-associated Bloodstream
Infection (CLABSI) rates to zero across all of their ICUs for the past six
months with the following strategies:
- Implemented the IHI Central Line Insertion Bundle at high compliance.
- Initiated house-wide, extensive staff education and incorporated annual competencies for central lines into all staffs’ job descriptions calling for accessing the vascular system.
- Implemented a maintenance bundle in 2011 when they recognized that the CLABSIs they did have were occurring, on average, ten days after line insertion, indicating inoculation was most likely happening after line insertion. The bundle included: strict hand hygiene when the central line was entered/manipulated; scrubbing hubs/ports with a sterile 70 percent isopropyl alcohol wipe for at least 15 seconds prior to entering to administer medications, draw blood, etc.; and ensuring all ports were capped at all times. Cap styles were changed and standardized throughout the hospital to promote better disinfection.
- Ensuring line dressing changes were performed according to policy written based on the most up-to-date published scientific evidence.
- Ensuring daily patient rounds to assess need for medical devices such as central lines to promote discontinuation unless medically indicated. (A checklist was developed to help guide these rounds).
- Ensuring blood specimens were consistently drawn per current medical science recommendations, e.g. not drawn through central lines unless there was no other alternative.
In early 2012, there was a cluster of CLABSI infections in
the hospital. Unable to find a single cause for the infections, the team
searched for additional prevention strategies. At the NC Prevent CLABSI
in-person conference in May 2012, they learned about the interventional patient
hygiene (IPH) strategy of bathing with the antimicrobial solution chlorhexidine
gluconate (CHG). A cost analysis showed the cost-per-bath would increase by
$4.68 for the CHG bathing, but there would be an estimated cost savings of
$114,695 if CLABSI rates were to decrease to zero. Subsequently, VAST developed
a three-month pilot in their surgical ICU. There were no CLABSIs during the
pilot, so the CHG bathing protocols were implemented throughout the house.
CLABSI rates fell to zero from July through December 2012 in all four of CaroMont
Health’s ICUs. The team credited strong support from the organization and the
Chief Medical Officer.
Contact
David Avalos, BSN, RN, OCN, CaroMont Infection Preventionist at AvalosD@CaroMontHealth.org.
Excerpted from N.C. Quality Highlights, Feb. 2013. N.C. Center for Hospital Quality and Patient Safety
Excerpted from N.C. Quality Highlights, Feb. 2013. N.C. Center for Hospital Quality and Patient Safety
