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

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Presentation on theme: "Central Line Associated Blood Stream Infection Prevention Project Gabrielle Hanlon, Project Manager Tony Burrell, Chair ANZICS Steering Committee."— 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 – 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/pack76% wear hats43% wear masks43% Chlorhex handwash88% sterile gown & gloves100% Chlorhex & alcohol skin prep100% full body draping41%

10 Clinical practice CVL insertion & maintenance Chlorhex patch20% Impregnated CVC59% Chlorhex body-wash25%

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

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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 – 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 Measure CLABSI 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”

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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 MonTuesWedThursFriSatSun Bed 1100 Bed 2011 Bed 3011 Bed 4110 Total232 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

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40 Thankyou


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