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CRBSI Reduction: The Long Version

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  • 1. CRBSI Reduction The Long Version The Methodist Hospital(Methodist DeBakey Heart & Vascular Center CVICU) Faisal Masud MD, FCCP Seven Y J S Year Journey (2003 2010) (2003-2010)
  • 2. High Rates of CRBSI• We looked at rates of CRBSI in 2003, and they were high for our Newly Introduced Intensivist Team in ICU (even though they were below the 50th percentile).• We choose this initiative as it was causing misery and deaths to our patients in-front of our eyes• We app oac ed with the mind set o NOT accept g e approached t t e d of O accepting Infections as a routine part of medical care even when it was NOT a popular issue in 2003
  • 3. The InterventionA multidisciplinary group (ICU physicians, Nurses, Infection Control, Nurse Practioners,Physician Assistants, ID physicians) reviewed everything. And Identified all the issues 1. Education & Awareness campaign. 2. All residents did an Mandatory Infection Control training and best practices review prior to insertion of lines. 3. Hand H i 3 H d Hygiene campaign for all healthcare providers and f il members. i f ll h l h id d family b 4.Use of Antiseptic/ Antibiotic coated catheters as routine. 5. Dressing change twice a week and Nursing champion led audits 6. Line cart and Mandatory full barrier precaution 7. Check list 8. Early removal 9. Sharing of results on a monthly basis10. Repeating these steps regularly as new nurses, residents etc came on board.
  • 4. The Results• All CRBSI were measured according to criteria set by NNIS/NHSN arm of CDC during the time period of 7 years years.• We had a 90% reduction of CRBSI from our baseline rate of 2003 until 2010 over a 87,000 plus central line days. , p y• 240 + CRBSI avoided• More than 9 Million dollars saved• Many lives saved• Very well received by administration, Physician and Nursing. It allowed all nay sayers to become our supporters
  • 5. Engaging Others• The process was driven by a Physician Champion, however it was a multidisciplinary effort. p y• Management support increased when they saw initial reduction and then they supported us by getting new technology and manpower manpo er in order to achieve o r goals achie e our• There is no one person but a group, compromising of doctors, nurses, Infection control and Infectious disease who pushed this , p long term initiative.• Physicians – were they most challenging to change. Issues of autonomy, buy in, adherence to evidence b d practice as a t b i dh t id based ti routine were the hurdles.
  • 6. Greatest Learnings/Largest Challenges – THE best learning was that there is no ONE magical solution or silver bullet. It is a series of steps which bullet have to done right every single time. – The biggest obstacle was g gg getting buy in and sustaining g y g the passion to reduce CRBSI This project has already impacted other areasin the hospital and resulted in decrease in rates of infections in many categories.
  • 7. Your Best Advice• Sharing of Data with ALL stakeholders is critical.• Persevere, Change is Hard.
  • 8. Sustaining Change• We measure rates on monthly basis and they are shared with all stake holders monthly. It is done to p up trend before they y pick p y become a problem.• We did have a slight back slide when Ultrasound usage was introduced for line placement, we evaluated our sterile practices for using ultrasound, did education of users of ultrasound. Following g , g year, our rates of CRBSI went down again.• Physician, Nursing and Infection Control champions keep on reminding care givers about the importance of reducing CRBSI.

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