Innovation & Early Adoption: The Impact of Tegaderm CHG on CLABSI Rates

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3M Health Care, one of 3M’s six major business segments, provides world-class innovative products and services to help healthcare professionals improve the practice, delivery and outcome of patient care in medical, oral care, drug delivery, food safety and health information markets. Learn more at http://go.3M.com/TegadermCHG

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Innovation & Early Adoption: The Impact of Tegaderm CHG on CLABSI Rates

  1. 1. Innovation & Early AdoptionThe Impact of Tegaderm™ CHG on CLABSI Rates Rebecca K. Aulbach, MS, RN-BC, ACNS-BC Clinical Nurse Specialist for Education & Quality Judy Holmes, MT (ASCP), CIC Infection Preventionist St. Luke’s Episcopal Hospital Houston, Texas Acute care community teaching hospital 823 licensed beds 12 ICUs - 157 ICU beds Predominant patient populations: Cardiovascular Solid Organ Transplant Pulmonary Neurology / Neurosurgery Renal Hepatology
  2. 2. The Issue – CLABSI Rates Best Practice Team for BSI – October 2005 Staff education on the central-line dressing changes and BSI prevention, central-line iinsertion b dl t l li ti bundle CLABSI Rates (2006-2008) Reduced but Erratic Greater than the goal of “ZERO” Central-line Dressings  Dressing practice:  Antimicrobial-coated catheter with transparent dressing, or  Non-coated catheter with chlorhexidine sponge dressing  Confusion - when to use chlorhexidine sponge dressing  Dressing integrity – inconsistent  No Line Insertion issues  Mandatory reporting and CMS reimbursement
  3. 3. The Innovation: A new concept dressing - Tegaderm™CHG Tegaderm CHG No proven outcome data in 2008BSI Best Practice Team  Infection Preventionist, Clinical Nurse Specialist, Nurse Managers, Unit-based Clinical EducatorsPilot January 2009  n=307 Tegaderm™CHG dressings  Multiple types of CVCs  Only 1 “primary” BSI - femoral line primaryValue Analysis Justification:  Clinical:  One-step application  Good visibility of insertion site  Gel molds around line at insertion site  Adheres and seals site even when dressing edges Adh d l it h d i d not fully intact with skin - “good stickability”  Patient comfort and preference
  4. 4. Value Analysis Justification: Financial 2008 Jan-Dec Usage Total Costs CVC Dressing Kits 26,662 $ 92,337.25 Chlorhexidine sponge 11,439 $ 58,667.59 Total $161,004.84 Projected CVC Kit Tegaderm™CHG Tegaderm CHG 27,000 27 000 $ 259 470 00 259,470.00 Chlorhexidine sponge 750 $ 4,190.40 Projected Total/Year $ 263,660.00 Less Biopatch use <10,689> <$ 62,209.98> Projected $ 201,450.02 Increase from 2008 $ 40,445.18 One BSI From IHI.org $3,700 to $29,000
  5. 5. The InterventionCVC Dressing Kit change (outside vendor)Extensive Education Campaign - 2009 & 2010  Educational materials  Central Line Validation - HOT SHEET UPDATE  Procedural criterion check lists  Central Line Access & Dressing Change Educational Materials (From Infection Control):  Infection rate information  NNIS data  Excerpts from CDC-MMWR Guidelines on IVC-related infections  Pictures of good and unacceptable dressings  Key points on dressing changes.  House-wide education  Teaching Team: 3M Representative & RN Super-user  Return demonstration by RNs  All shifts/weekends
  6. 6. RATE 0.000 0.500 1.000 1 500 1.500 2.000 2.500 3.000 3.500 Jan-Mar 2004 4.000 Apr-Jun 2004 CL LCL UCL Jul-Sep 2004 Oct-Dec 2004 Jan-Mar 2005Data1 Apr-Jun 2005-1 Sigma Jul-Sep 2005 Oct-Dec 2005 Jan-Mar 2006 Apr-Jun 2006UCL Jul-Sep 2006-2 Sigma Oct-Dec 2006 (Rate per 1000 Central Line Days) Jan-Mar 2007 Apr-Jun 2007LCL Jul-Sep 2007 TIME Oct-Dec 2007+2 Sigma Jan-Mar 2008 Apr-Jun 2008 Jul-Sep 2008 Oct-Dec 2008+1 Sigma Jan-Mar 2009Linear (Data1) Apr-Jun 2009 Jul-Sep 2009 Oct-Dec 2009 Jan-Mar 2010 JANUARY 2004 TO MARCH 2011 Average Tegaderm with CHG Implementation after Apr-Jun 2010 Return Demonstration House-wide Education & QUARTERLY CLABSIs FOR THE ICUs Jul-Sep 2010 Oct-Dec 2010 0 124 0.124 1.623 3.122 Jan-Mar 2011
  7. 7. CENTRAL LINE-RELATED BLOODSTREAM INFECTIONS ESTIMATED ANNUAL COST – ICU 2004 - 2010 $2,500,000 80 73 75 $2,175,000 70 $2,000,000 $2,117,000 58 54 60ANNUAL CLABSIs $$ ICU 50 CU 50 # OF CLABSIs IC 45 $ $1,500,000 $1,682,000 $1,305,000 $1,450,000 40 $1,266,000 $1,000,000 30 October 2009 - I O b Introduced d d 19 Tegaderm with CHG dressing along with Re- 20 education & Return $500,000 $551,000 10 $270,100 $277,500 $70,300 $199,800 $199 800 $214,600 $214 600 $185,000 $185 000 $166,500 $ $0 0 2004 2005 2006 2007 2008 2009 2010 TIME Maximum cost Minimum cost BSI-NNIS ALL ICU Infection
  8. 8. CENTRAL LINE-RELATED BLOODSTREAM INFECTIONS ESTIMATED ANNUAL COST – FLOORS 2005 - 2010 $1,600,000 60 $1,479,000 $1 479 000 $1,400,000 50 51 $1,200,000 $1,131,000 40 ABSI $$ FLOORS $889,000 BSLIs FLOORS $1,000,000 39 $800,000 30ANNUAL CLA $696,000 $696 000 # OF CLAB 31 $609,000 $600,000 24 20 21 $377,000 $ 00,000 $400,000 13 10 $200,000 $137,700 $144,300 $114,700 $88,800 $77,700 $48,100 $0 $ 0 2005 2006 2007 2008 2009 2010 TIME Minimum cost Maximum cost # CLABSIs floors
  9. 9. Engage  Learn  Sustain g g Engage  Early Adopters – Drivers of Change  Clinical Nurse Specialist  Infection Preventionist  L d hi – St k h ld Leadership Stakeholders  Medical and Clinical Directors of Infection Control  Vice-President & Chief Nursing Officer  Chief Quality Officer  Nurse Manager - worked staff schedules  Staff  Volunteer RN Trainers  Unit Clinical Educators/ Quality Coordinators  Unit -based CLABSI Prevention Super Users champion - train – evaluate - coach  3M Representative
  10. 10. Engage  Learn  SustainLearn  Monitor - Report - Aggregate  Unit-based monthly CVC dressing evaluation  Infection Control – outcome data – NNIS  Questionable insertion sites reported to IC and CNS  Established new procedure for “white flecks”  Consulted with hospital and 3M wound specialists  No Sting Barrier Film (patient care supply)Sustain  CVC dressing monitors entered into VSurvey  E h CLABSI immediate reported to Nurse Manager Each i di t t dt N M  Address unit-based CLABSI rate changes  Chlorascrub Swab for “scrub-a-hub” scrub a hub  Continued Vigilance

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