Toward Eliminating Central Line Associated Blood Stream Infections BNVBBVB Realities of life on the front lines
Learning Objectives To explore how to implement evidence-based behaviors to prevent CLABSI To understand real life challenges involved in doing this work
Evidence-based Behaviors to Prevent CLABSI Remove Unnecessary Lines Wash Hands Prior to Procedure Use Maximal Barrier Precautions Clean Skin with Chlorhexidine Avoid Femoral Lines I want to highlight 5 strategies specifically because they are well supported by the evidence. Central lines should be discontinued when they are no longer needed. Strict compliance with hand washing is essential. we should use MBP during cl insertion, We should use chlor for skin preparation if the patient is not allergic, and if we have a choice, subclavian sites are preferred over IJ or femoral sites. The benefit of removing central lines when they are no longer needed is self-explanatory . One point that I would ask you to consider though is whether you have a mechanism in place to assess the need for central access for your patients on a daily basis. If not, you need to develop one and I would be happy to share with you our approach. What about hand washing? MMWR. 2002;51:RR-10
Identify Barriers Ask staff about knowledge Use team check up tool Ask staff what is difficult about doing these behaviors Walk the process of staff placing a central line Observe staff placing central line
Observations from the Front Line Doctor – Nurse-Doctor Observations from the Front Line
ICU staff must assume responsibility for reducing CLABSI Partnership To help with 4Es, Partner with Infection control staff Hospital quality and safety leaders Nurse educators Physician leaders ICU staff must assume responsibility for reducing CLABSI
Action Plan Meet with ICU team, infection control staff, quality and safety leaders, nurse educators and physician champions Understand barriers (walk the process) Use 4E grid to develop strategy to engage, educate, execute and evaluate Make weekly task list