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Central Line Associated Blood Stream Infection Prevention Project

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Presentation on theme: "Central Line Associated Blood Stream Infection Prevention Project"— Presentation transcript:

1 Central Line Associated Blood Stream Infection Prevention Project
Gabrielle Hanlon, Project Manager Tony Burrell, Chair ANZICS Steering Committee

2 Background ~ 300 ICU CLABSI/yr in Australia Costs $14,000 per case
extra $AU4.3 million 3,000 extra bed days Attributable mortality 4-20% CLABSI preventable

3 Background CLABSI reduction projects Pronovost (2006) & others (15yrs)
NSW CLAB ICU ( ) 3.0 → 1.2/1,000 WA Safety and Quality Investment for Reform (SQuIRe) Program 2006 → 0.55/1000

4 This project ACSQHC funded ANZICS National project Adult & paed ICU
Public & private Build on existing work

5 Objectives Decrease rate of CLABSI in Australian ICUs to <1/1000 line days Accurately and consistently measure the rate of CLABSI in ICUs throughout Australia Timely reporting to clinicians Benchmarking

6 Preparation Review current practice (April/May 2010) Surveillance ICU
Definition Reporting method & timeframe ICU CVL insertion Knowledge of surveillance

7 Surveillance Across Australia Majority data collected by ICPs
A few ICUs collected some data Not all jurisdictions did CLABSI surveillance Inconsistent definitions, reporting (method & timing), benchmarking Variable practises in private sector No national reporting or benchmarking

8 ICU practice ICU Directors/Nurse Managers Survey
53/100 ICUs: 24 doctors, 39 RNs (not NSW, ACT) Variable knowledge of surveillance processes Some did not know CLABSI rate “but it’s low” Variable compliance with “best practice” re CVL insertion

9 ICU practice CVL insertion – total 51 ICUs have trolley/pack 76%
wear hats % wear masks % Chlorhex handwash 88% sterile gown & gloves 100% Chlorhex & alcohol skin prep 100% full body draping 41%

10 Clinical practice CVL insertion & maintenance Chlorhex patch 20%
Impregnated CVC 59% Chlorhex body-wash 25%

11 Schedule First Outcome assessment & national reporting both require
national definition implementation/interpretation guide Then improve CVL insertion practises

12 National definition minimise change if possible numerator - NHSN 2008
denominator - line days implementation guide inc “other infection” definitions

13 National definition Am J Infect Control 2008:36;309-32


15 National definition All jurisdictions adopting as able
New surveillance commencing

16 National reporting No duplication at any step
Jurisdictions forward data to ANZICS if they already collect it (hospital-level data only) Some individual public & private hospitals forward data to ANZICS (if above n/a)

17 National reporting ANZICS generate reports Secure log-in Access:
Self vs other SA ICUs Self vs other in same CICM level/other PICUs nationally Self vs all in Australia Secure log-in Access: ICU director & NUM Inf Cont ? other

18 Monthly reporting

19 Annual report

20 Interim goals Foundations National definition √
Implementation (interpretation) guide √ National reporting √ Now Improve CVL insertion practises

21 Improving Central Line Insertion

22 Quality not research However....
Based on evidence derived from research Focus on sustainable practice vs short intervention process & outcomes ongoing measurement

23 Method - Clinical Practice Improvement
Too complex & time-consuming ...

24 Method Keep It Simple Measure CLABSI
Incorporate change into usual practise Review individual cases (ICU & IC +/- ID) Check compliance with insertion process Keep measuring CLABSI & review

25 Approach Assumptions relevant to Australia
multidisciplinary clinical team ward rounds occur twice/day Establish multi-disciplinary project teams ICU director & nurse manager or senior dr & ns Infection Control/ID support Others as appropriate

26 Intervention Joint medical & nursing responsibility
Insertion & maintenance guideline based on NHMRC/ACSQHC Guidelines CDC Expert group Core items Optional items

27 Insertion Maximum barrier precautions Hat Mask CHG handwash
Sterile gloves & gown CHG & ETOH skin prep & allow to dry Full-body drape Maintain aseptic technique

28 Checklist

29 “Reminder” Proceduralist acknowledges he/she would like to be reminded if he/she misses one of the steps below; eg. “ I would like you to watch me and if you see that I forget an important step in the procedure I want you to tell me”


31 Other suggestions CVC (inc swan & vascath) trolley Appropriate site
Options if rate higher than goal chlorhexidine patch at insertion site impregnated CVC daily chlorhexidine body wash Maintenance Very limited re-wiring of existing lines Replace lines with a blocked lumen No disconnection & re-connection of lines (inc HF)

32 Guideline contents Scope Definitions Selecting a central line
Selecting a site Aseptic technique Maximum barrier precautions Stopping the procedure if asepsis breached Daily review local infection need for line

33 Guideline contents Line replacement inc re-wiring Blocked lumens
Changing fluids & administration sets Needleless connectors Dressings CHG patches Drug administration (CHG & ETOH swabs) CHG body wash

34 Support Website CVC insertion & maintenance guideline References
Audit tools/checklist Line day calculator Secure discussion forum ANZICS CLABSI Reporting Program

35 What now? Establish CLABSI reporting process
Form the team - Dr, Ns, ICP, ?other Review your protocol Identify changes required & materials needed (eg. trolley, big drapes, ?culture) Develop education strategies for all staff Implement changes Check compliance Review CLABSI rate & compliance

36 Counting line-days Line day counts should be done
3 times a week, eg. Mon, Wed, Fri At the same time By asking the question: Does this patient have a central line, PA catheter/swan, swan sheath, vascath (or other haemofiltration catheter), or a PICC? This job does not require nursing/technical knowledge This is done by Infection Control in Vic & WA public ICUs

37 Counting line-days Mon Tues Wed Thurs Fri Sat Sun Bed 1 1 Bed 2 Bed 3
Bed 2 Bed 3 Bed 4 Total 2 3 1 means the patient in that bed has at least 1 central line 0 means either the bed is empty, or the patient doesn’t have a central line



40 Thankyou

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