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The Eight Annual Evidence Based Practice Conference October 29,2011

The Eight Annual Evidence Based Practice Conference October 29,2011

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  • 1. Donna Matocha BSN, RN, CNRNRush-Copley Medical Center
  • 2.  The Institute for Healthcare Improvement’s Central Line Bundle was implemented in our intensive care unit at Rush-Copley Medical Center Goal of zero not obtained Quality collaborative established in 2008 ◦ IV Therapy Coordinator/Nurse Educator and Infection Control
  • 3.  Deficit Reduction Act - February 8, 2006 ◦ Reduce expenditures for “reasonably preventable” diagnosis by implementing EBP guidelines (Graves & McGowan, 2008) ◦ Zero tolerance for CLABSIs (Graves & McGowan, 2008) Centers for Medicare and Medicaid – October 1, 2008 ◦ Discontinued reimbursement for CRBSIs ◦ (Graves & McGowan, 2008)
  • 4. EBP DS Education• Harnage • Harnage • Harnage• Berenholtz • Collignon • Collignon • East • Berenholtz • Warren DS = Daily Surveillance
  • 5.  Hand hygiene Insertion site and dressing management Cap care Flushing protocol Daily monitoring of all IV catheters Develop policies and procedures based on Evidence
  • 6.  Inconsistent practice was noted Dressing labels were absent Multiple dressing changes were necessary due to ineffective dressing securement CHG impregnated patch was placed upside down 75% of the time Improper training for negative pressure valve caused clotted lines Breaks in aseptic technique identified
  • 7. Target ZeroProductimprovementsStaff Educationand TrainingEBP into Policiesand Procedures
  • 8.  Product assessment completed with multiple changes Education with audits & reinforcement Collaboration with Intervention Radiology, Shared Governance & Discharge Planning
  • 9.  CLABSI Education Aseptic technique training initiated Layered kits were designed with improved transparent dressing. 3.15% Chlorhexidine gluconate/70% isopropyl alcohol solution implemented for skin prep and dressing changes (2009) Chlorhexidine impregnated patch placed during line placement
  • 10. Layer 1 Layer 2
  • 11.  CLABSI Rate ◦ Review each CLABSI episode for specific issues and preventable causes ◦ Provide feedback and education for staff who charted on a line that resulted in a CLABSI.
  • 12. Central line associated infections per 1000catheter line days: July 2007-June 2008: 1.27 infectionsMedian rate for all central lines in critical care units is 1.8 – 5.3 per 1000 catheter days (Harnage, 2007) July 2008-June 2009: 0.51 infections July 2009-June 2010: 0.45 infections July 2010-June 2011: 0.00 (no infections)
  • 13. CLABSI Rate1.41.2 10.80.6 CLABSI Rate0.40.2 0 Jul 07 - Jun Jul 08 - Jun Jul 09 - Jun Jul 10 - Jun 08 09 10 11
  • 14.  Practice protocols must be followed at all times Prompt identification of individual CLABSI episodes with prompt intervention to the specific individuals involved have been shown to be cost effective and can be implemented into most hospitals (Collignon, et al., 2007). Layered kit design increases aseptic technique compliance Efficacious products play an important part in getting to zero Process changes are important parts of the puzzle. Empowering staff through education that increases knowledge, understanding and skills will improve patient safety and patient outcomes.
  • 15.  Berenholtz, S. M., Pronovost, P. J., Lipsett, P. A., Hobson, D., Earsing, K., Farley, J. E., Milanovich, S., Garrett-Mayer, E., Einters, B. D., Rubin, H. R., Dorman, T. & Perl, T. M. (2004). Eliminating catheter-related bloodstream infections in the intensive care unit. Critical Care Medicine, 32 (10), 2014 – 2020. Collignon, P. J., Dreimanis, D. E., Beckingham, W.D., Roberts, J. L. & Gardner, A. (2007). Intravascular catheter bloodstream infections: An effective and sustained hospital-wide prevention program over 8 years. Medical Journal of Australia, 10 (19), 551 – 554. East, D. & Jacoby, K. (2005). The effect of a nursing staff education program on compliance with central line care policy in the cardiac intensive care unit. Pediatric Nursing 31, (3), 182 – 184. Graves, N. & McGowan, J. E. (2008). Nosocomial infection, the deficit reduction act and incentives for hospitals. Journal of the American Medical Association, 300 (13), 1577 – 1579. Harnage, S. A. (2007). Achieving zero catheter related blood stream infections: 15 months success in a community based medical center. Journal of the Association for Vascular Access, 12 (4), 218 - 223. Warren, D. K., Zack, J. E., Mayfield, J. L., Chen, A., Prentice, D., Fraser, V. J. & Kollef, M. H. (2004). The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU. Chest, 126, 1612 – 1618.

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