1. Toward Eliminating Central Line Associated Blood Stream Infections
BNVBBVB
Realities of life on the front lines

2. Learning Objectives
To explore how to implement evidence-based behaviors to prevent CLABSI
To understand real life challenges involved in doing this work

3. 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

4. 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

5. Observations from the Front Line
Doctor – Nurse-Doctor
Observations from the Front Line

6. 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

7. 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