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Reduce the Rate of CRBSI by Application of Central Line Care Bundle in ICU

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About 3M Health Care
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  • 1. Reduce the Rate of Catheter-RelatedBloodstream Infection by Application of Central Line Care Bundle in ICUSir RunRun Shaw Hospital affliated to Medical College of Zhejiang University, China LinFang Zhao,RN,MS g , , 2009 – 2011
  • 2. The Issue – CRBSI• In 2009, ICU has a total of 6064 catheter days, 28 patients diagnosed with CRBSI• No SOP for insertion of CVC
  • 3. The InterventionCentral Line Bundle Execution – Set-up team (Administrator of hospital, ICU’s doctor and nurses, Infection Set up ICU s Control nurse, Infectious Disease Department’s doctor ) − Definition the standard diagnosis of CR-BSI − Identify the standard method of blood culture y − Develop the SOP of CVC − Key material preparation (work with staff from central supply department, collecting what we need and what we can get) − Standardize skin prep and practice (we don’t have 2% CHG in the market , 2% CHG have been adapted for use 75% alcohol for 2-3 times plus 5% Povidone Iodine for 3 times) − Develop the electronic evaluation and report form − Use checklist to monitor the whole insertion process − Staff buy-in/education − Build a culture of CR BSI prevention CR-BSI
  • 4. The Results• After implementation of central line bundle, the average bundle CRBSI Rate CRBSI-Rate (‰Cather day) number of catheter-related CRBSI-Rate 6 5.68 (‰Catherday) 5 bloodstream infections per 4.57 4.41 4 3.61 1000 catheter d th t days d decreasedd 3 2.88 2 2.00 from 4.61% in 2009 to 1.86% 1.22 1.26 1 0 in 2010 (P<0.05) 2009Q1 2009Q2 2009Q3 2009Q4 2010Q1 2010Q2 2010Q3 2010Q4• Changes − From small to maximal sterile barrier precaution − Strict skin antiseptic − Daily evaluation and record was done by nurse − Accept new theory of CR-BSI
  • 5. Engaging Others• The team members discuss what and how to do, they make the t t th strategy to drive th process t d i the• Doctors from ICU are the most important people, cause they insert the CVC line for patient• Doctor was the most supportive, also the most difficult to engage, engage as the process are more complex than previous• Infection Control department are the most supportive one, they are monitoring the CR-BSI rate and hand in result to CR BSI ICU director and Administrator
  • 6. Greatest Learnings / Largest Challenges• CR-BSI is preventable by implementation the evidence based evidence-based prevention measures• Biggest obstacle is to convince them to accept and follow the central line bundle, especially insert line via subclavian vein• What we learned from this project g us faith to achieve p j give “zero CR-BSI”
  • 7. Your Best Advice• Team work is key point to reach the goal• Administrator of hospital must involved• Obtain understanding of health care worker and patient, especially d t i ll doctor
  • 8. Sustaining Change• We collect and analysis data every month, and give a report every quarter• The rate of CR-BSI is low, but not stable, it can be considered as ‘back-sliding’, because the doctors rotation back sliding and state of emergency insertion. They may not follow the SOP• The team is still working together, the rate of CR-BSI has been identified as a quality indicator of medical care