Central Line Blood Stream Infections Houston Medical Center Tomeko Fuller, RN, BSN Clinical Resource Manager

Points of Discussion Goals Objectives History Problem Methodology Implementation New Process Outcome

Goals Ultimate Goal - Zero Central Line Blood Stream Infections Goal for 2012 – To have 25% reduction in Blood Stream Infections at Houston Medical Center.

Objectives To create a cost effective process to reduce Blood stream infections utilizing resources available with our Central Line Dressing changes.

Problem During rounds it was noted that Central Line dressings were not being changed per our policy. Some dressing were not changed correctly or in the time frame set. No accountability for who was responsible for the dressing change. Day or Nightshift nurse No consistency Recommendation was made to decrease the number of staff members responsible for dressing changes.

Methodology A new process was discussed with the Infection Prevention & Control Manager, Director of Nursing and IV Therapy Manager to utilize IV Therapy nurses . Implementing a cost-effective process. A process focused on ensuring efficient use of time by all staff.

Implementation Discussed process with the Med/Surg, ICU and IV Therapy Nurse Managers and Clinical Coordinators in a meeting. Arranged a Trial Period June 6 -27, 2012. Discussed With IV therapy nurses the process and expectations. Educated IV Therapy nurses on the documentation in Meditech. Contacted IT department to give nurse permission to access patient information. Arranged for supply availability to complete dressing changes Definined a way to accurately capture supply charges.

New Process ROUTINE central line dressings will be changed on WEDNESDAY by IVT nurse. The ANM or charge nurse for each Med/Surg area will FAX a list of the patients that have a central line to IV Therapy on Tuesday evening or early (before 0800) Wednesday morning. Supplies for the dressing change will be brought from IV Therapy and restocked on the Nursing unit. PICC = PICC dressing tray, biopatch, 1 end cap for each lumen, saline flush Central line = Central line dressing tray, 1 end cap for each lumen, saline flush Port= Huber needle, Central line dressing tray, 1 end cap, saline flush IVT nurse will change the dressing, communicate with the primary nurse and/or charge nurse and document the procedure in the patient’s record. The IVT Manager will keep the Med/Surg Managers and Infection Prevention & Control Manager informed of findings each week during the trial

Trial Phase June 6, 2012 A total of 13 dressings changed 2 Main= 5 (2 PICC, 1 IJ, 1 femoral line, 1 Port) 3 Main = 3 (2 ports, 1 PICC) 4 Main = 1(sutured PICC) 2 N= 2(1 PICC and 1 IJ) 5 NW= 2(1 port, 1 PICC) The IVT nurses reported that it went very well, all the staff was appreciative and helped with making sure supply charges were completed appropriately. Remember…IVT will bring supplies to the room with them and restock from your supply room. This insures that the patient gets charged appropriately and that no supplies are wasted. June 13, 2012 Total of 9 dressings changed 2 Main = 4 (1 port, 3 PICCs) 3 Main = 3 (1 port, 1 PICC and 1 Central line-double lumen) 4 M= 0 2 N= 0 5NW= 2 (2 PICCs) No problems reported. Remember we will restock from YOUR supplies

Trial Phase June 20, 2012 Total of 21 dressings changed 2 Main = 8 (1Trauma cath, 7 PICCs) 3 Main = 7 (2 ports, 5 PICCs) 4 M= 2(1 port, 1 PICC) 2 N= 1 (port) 5NW= 3 (2 PICCs, 1 port) No problems reported. June 27, 2012 Total of 14 dressings changed 2 Main = 7 (1 triple lumen central line, 3 PICCs, 3ports) 3 Main = 2 (1 port, 1 PICC) 4 M= 0 2 N= 2 (1port, 1 PICC) 5NW= 3 (2 PICCs, 1 port) No problem reported

Outcomes Per our Infection Prevention & Control Department we have NOT had any reportable Central Line Blood Stream Infections since July 1, 2012

Outcomes 1

Outcomes 2 Baseline CLABSI data: 47% Reduction House wide; 50% Reduction ICU 2008-2011 2008: 15 cases house wide, 6 ICU cases 2009: 13 cases house wide, 3 ICU cases 2010: 10 cases house wide, 2 ICU cases 2011: 8 cases house wide, 3 ICU cases 2012: (YTD) 5 cases house wide, 1 ICU case

Team Members 1 Team Members Melinda Hartley, DNP, RN, NE-BC, VP Patient Care Services/CNO Laura Gentry, RN, BSN, Director of Nursing Tomeko Fuller, RN, BSN, Clinical Resource Manager Barbara Adkins, RN, Nurse Manager Cardiac/ Telemetry Services Tim Bennett Infection Prevention & Control Manager Karen Bowen Infection Prevention & Control Assistant