Healthcare Management Capstone ( CLABSI) Stratford University.

1. Healthcare Management Capstone
MSc in Healthcare Administration
The impact of Healthcare Management on Controlling (CLABSI)
(Central Line-Associated Blood Stream Infections)
Dr. Hamida Hussein
Student Master HCA: Amer Bani Ahmad

2. Outline
- What is a central line-associated bloodstream infection (CLABSI) ?
- What is a Central Line?
- what is the function of central line?
-The SWOT analysis (CLABSI).
- Graph/ statistics
- Central Line Care.
- How you prevent catheter-associated bloodstream infections from doctors, nurses and Healthcare provider.
- How you manage patient with central line in home "Home care ".
- Making Health Care Safer.
- Conclusion

3. A central line-associated bloodstream infection (CLABSI) is a serious infection that
occurs when germs (usually bacteria or viruses) enter the bloodstream through the
central line. (CDC,2010)“.
What is a Central Line?
Central line is a sterile catheter or tube that often placed in a large vein
like jugular, or subclavian veins to give regular medications and fluids,
collect blood for medical tests, also Administration of blood or blood products.
Central line is commonly used in intensive care unit’s patients, who need along stay
for specific care, those patients are very difficult to insert venous access daily IV’s,
so, the doctors decide to insert a central line.
What is a Central Line-Associated Bloodstream Infection (CLABSI)?

4. Central line is different from IV’s because central line is inserted and leads the major vein that is close to the
heart or in one of the great vessels, and can remain in its place for weeks or months, and could be the reason for
serious infections that called as central line associated blood stream infection CLABSI.
Central line-associated bloodstream infections (CLABSI) is a term used by US Centers for Disease Control and
Prevention’s (CDC’s) National Healthcare Safety Network (NHSN).
Infection can occur when bacteria grow in the line and spread into the bloodstream.
• is a primary blood stream infection (BSI) in a patient that had a central line within the 48-hour period before the
development of the BSI.
• If BSI develops in a patient within 48 hours of discharge from a location, attribute the CLABSI to the
discharging location.

5. Why are CLABSIs so important?
Impact
- Central line-associated bloodstream infections are often devastating infections.
- It is estimated that almost 300 million catheters are used each year and nearly 3 million are central venous
catheters (CVCs), otherwise known as central lines.
- An estimated 41,000 central line associated bloodstream infections occur in U.S. Hospitals each year, causing
prolonged hospital stays, increased costs, and risk of mortality. CDC
- Estimated costs for one central line infection ranges from $6,000 to $30,000.
- CLABSIs are serious infections typically causing a prolongation of hospital stay and increased cost and
risk of mortality.

6. Graph/ statistics for CLABSI.
ICUs reduced infections on average from 2.5 infections per 1,000-line days in 2004 to .83 infections per
1,000-line days in 2009. Further, 60% of the ICUs evaluated prevented central line infections for a year or
more, and 26% went without infections for at least two years.

7. The following are considered great vessels for the purpose of reporting central line associated
infections and counting central line days:
• Aorta
• Pulmonary artery
• Superior vena cava
• Inferior vena cava
• Umbilical artery and vein for neonates
• Brachiocephalic veins
• Internal jugular veins
• Subclavian veins
• External iliac veins
• Common femoral veins
• Signs or symptoms: temperature above normal, fever, chills, or the skin around the
central line is painful ,tenderness, red, swollen and oozing.

8. Capstone SWOT analysis (CLABSI).

9. →Strengths: all health care providers and managers commitment in the infection control department, well-structured
department , clear policies and managerial hierarchy at all levels of the department.
→Opportunities: Of commitment at the level of the infection control received from CDC, NHSN and joint commission.
- infection control metrics available but not explained to staff.
- Better staff satisfaction - morale.
- more support from leadership staff.
- Create awareness of infection control practice in hospital.
→Weaknesses: lack of awareness of the view of staff.
lack of immediate feedback and reinforcement.
Lack of awareness of the practice of infection control in hospital.
→ Threats: The short time of this project to apply .
-Resistance to change.
-Knowledge Deficit.

10. Central Line Care
A. Dressing:
1. All dressing shall be changed using sterile technique.
2. Gauze dressing should be changed daily for seven (7) days following
insertion, then every forty-eight (48) hour if no signs of infection or if the
dressing becomes loose, wet or soiled.
B. Frequency of Flushing
1. A physician’s order is required to flushed with heparin 10 u/ml.
2. Flushed twice a day, if no IV fluids infusing or treatment.
3. Flush before and after every use of antibiotics blood products utilize SASH technique.
S- Flush the device with 10 ml 0.9% sterile saline.
A- administer the medication/ draw blood work.
S- Flush the device with 10ml 0.9% sterile saline.
H- Flush the device with 2ml heparin (10 u/ ml).
C. Required to keep vein open
D. Change all injection ports every three days

11. To prevent Central line - associated bloodstream infections doctors,
nurses and Healthcare provider will:
1- Choose a vein where the catheter can be safely
inserted and where the risk for infection is small.
2- Clean their hands with soap and water
or an alcohol-based hand rub before putting in the catheter.

12. 3- Wear a mask, cap, sterile gown, and sterile gloves when
putting in the catheter to keep it sterile. The patient will
be covered with a sterile sheet. "Personal Protective Equipment PPE”
4- Clean their hands, wear gloves, and clean the catheter
opening with an antiseptic solution before using the
catheter to draw blood or give medications.
Healthcare providers: also clean their hands and wear gloves
when changing the bandage that covers the area where the catheter
enters the skin.

13. 5- Clean the patient’s skin with an antiseptic cleanser
before insert the catheter.
6- Decide every day if the patient still needs to
have the catheter. The catheter will be
removed as soon as it is no longer needed.
7-Carefully handle medications and fluids
that are given through the catheter.

14. “Some patients are sent Home from the hospital with a catheter in order to continue their treatment”.
1- Make sure you understand how to care for the
catheter before leaving the hospital.
For example, ask for instructions on showering or
bathing with the catheter and how to change the catheter dressing.
2- Make sure you know who to contact if you have questions or
problems after you get home.

15. 3-Make sure you wash your hands with soap
and water or an alcohol-based hand rub before
handling your catheter.
4-Watch for the signs and symptoms of catheter-associated
Bloodstream infection, such as soreness or redness
at the catheter site or fever, and call your healthcare provider
immediately if any occur.

16. Making Health Care Safer
-What Can Be Done:
1-US Government can
1-Develop and promote further guidelines and
tools that increase widespread adoption of best practices to prevent infections.
2-Engage partners to promote prevention.
3-Apply the success in reducing central line
bloodstream infections to other types of infections in health care. Identify which actions and
germs cause the most problems and how to prevent them.
4-Promote research of new methods to prevent bloodstream infections. Track and report.
progress toward reducing infections.

17. 2- State governments US can
1- Join, start, or expand programs to keep bloodstream
infections from happening in patients
with central lines.
2- Encourage facilities to join CDC’s infection
tracking system and validate their data (National
Healthcare Safety Network, NHSN).
3-Build partnerships with and give technical
support to hospitals, dialysis centers, and other
medical care locations.
Making Health Care Safer

18. 3- Hospitals, dialysis centers, and other medical care locations can.
1- Use CDC-recommended infection control guidelines every time a central line is put in
and for central line care.
2-Use central lines for hemodialysis only when other options are not available.
3- Use data for action. Track infection rates and
germ types with CDC’s National Healthcare
Safety Network (NHSN) to learn where and
why infections are happening, target actions to stop them, and track progress.
4- Recognize staff members or units that work hard to prevent central line infections.
5-Join state and local health department prevention programs, quality improvement projects, and state-
based partnerships to foster best practices.

19. 4- Doctors, nurses and Healthcare provider.
1- Use CDC-recommended infection control steps every time a central line is put in
and used.
2- Remove central lines as soon as they are no longer needed.
3- Be sure that all people taking care of the patient follow the right steps.
4- Speak up if someone is not following the right step.

20. 5- Patients and caregivers can
1- Ask doctors and nurses to explain why the central
line is needed, how long it will be in place,
and which infection prevention methods they will use.
2- Make sure that all healthcare providers clean
their hands with soap and water or alcohol-based
hand rub before and after caring for the patient.
3-Inform a nurse or doctor if the area around the
central line is sore or red, or if the bandage falls off or becomes wet or dirty

21. Conclusion
1- As Healthcare admin, we plan work to prevent central line associated bloodstream infection hospital to improve
healthcare to the patient and increase the quality. decrease cost and enhance patient safety.
2- As a healthcare provider and role model, we must be knowledgeable about infection transmission.
3-We must hold the highest standards and adhere to and educate infection prevention intervention such as hygiene,
aseptic technique and infusion – related care.
4-It is our responsibility to ensure our patient receive the best care determined by evidence – bases research.
5-Tools to reduce and eliminate infection have been provided to us.it is our role to utilize these tools to improve our
patient’s outcomes

22. 6-The impact of health care managements and the commitments of all health care providers in Hospital to do the
best, showed the improvement in decrease of CLABSI rate, from the beginning of the project.
7-Using the bundle of care, increase the training programs and lectures, improve the hand hygiene compliance and
insertion the central line with sterile technique had a significant impact in giving us the desired results that we want
in decreasing the CLABSI rate.
8-This project affected the staff’s knowledge, attitude, behavior and culture for the better than it was, and encourage
them to do the best with their patients.

23. Video Tutorial -final project
Greater Baltimore Medical Center/GBMC quality Metrics CLABSI. to See the video, click the link:
https://youtu.be/1Kn08TrEvCs

24. Questions:
1- What is a (CLABSI) ?
2- How you can prevent Central line - associated bloodstream infections ?

25. References :
Central-line associated bloodstream infections: Real world implementation strategies
https://www.sciencedaily.com/releases/2014/06/140611151155.htm
Bloodstream Infection Event (Central Line-Associated Bloodstream, Infection and non-central line-associated Bloodstream Infection).
https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf
Maryland Hospital Performance Evaluation Guide CLABSI Webinar.
https://www.slideshare.net/visualmatics/clabsi-webinar-final100610
Central Line-associated Bloodstream Infection (CLABSI) Based on 2011 CDC guideline for prevention of intravascular catheter-associated
bloodstream infections.
https://www.cdc.gov/hai/bsi/bsi.html

26. Thank you