Impact of Standardized Management of Central Venous Catheter


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Impact of Standardized Management of Central Venous Catheter

  1. 1. Impact of the Standardized Management CVC Hospital del Trabajador de Santiago Santiago, Chille RN MMarcela Quintanilla l Q i t ill January 1st to December 31st, 2010
  2. 2. The Issue• The Hospital del Trabajador de Santiago is a Hospital specialized iin t i li d trauma• The rate of IBSRC and Insertion Site increased in Intensive C U it b t I t i Care Unit between 2008 – 2009 years• With a surveillance system we found a great variability of procedures techniques for CVC maintenance
  3. 3. The InterventionInvolve: Meeting of physicians and nurses for analyzing the issueand to taking actions actions.Education: Train physicians (anesthetist, intensive carephysicians) and nurses on: – Add transparent dressing with Chlorhexidine gel pad (Tegaderm CHG) for covering CVC I.V. Sites (Non-Tunnelized) in patient in ICU. Except patients with history of allergy, burned patients, diaphoretics and the ones that have less than 24 hrs of installation. – Change the transparent Dressings every 5 days, preparing the skin with Chlorhexidine – Train in application and removal techniques for the transparent dressings – Surveillance bi-monthly bi monthly – Maintain monitoring
  4. 4. The Results• We compare the rate of IBTRC between 2009 and 2010• Th CVC IV Sit iinfection d The IV. Site f ti decreased f d from 3,8 to 2,7 x 1000 days• Cost related to 1 bacteremia according to American bacteremia, publications is between USD 3,700 to USD 29,000• Cost during 2009 = USD 145.0000. g Post-intervention cost decreased in 2,5 times.• Total Cost of the intervention in Hospital d Trabajador H it l dell T b j d = USD 11,300 11 300 (Training + Tegaderm CHG)
  5. 5. Engaging Others g g g• Engaging the ICU team with Medical Director and with th I f ti P ith the Infection Prevention C ti Committee support itt t• In stage 1, Clinical nurses didn’t accept the new technology (Tegaderm CHG) because they didn’t trust it t h l (T d b th did ’t t t it. Gradually nurses begun to trust in the new product and gradually results improved improved.• Nurses gained experience, so they could decide when to change the Transparent dressing according to the saturation of the Chlorhexidine gel pad.
  6. 6. Greatest Learnings / Largest Challenges g g g• Interventional plans based on effective actions are useful only with active and systematic surveillance• Have to consider in the intervention program the Demming s Demming’s quality Circle• Results must be measured considering the learning process of the people involved.• Infection Prevention Committees must lead this kind of issues and receive Medical Director support
  7. 7. Your Best AdviceStandardizing the practices of non- tunnelingCVC maintenance and continue with i t d ti ithactive surveillance.
  8. 8. Sustaining Change g gContinue with epidemiologic surveillance bi-monthly,measuring quarter rates with di t f db k of th i t t ith direct feedback f theclinical team.