Reducing CLABSIs by Nursing Driven Interventions …...Reducing CLABSIs by Nursing Driven...

Reducing CLABSIs by Nursing Driven Interventions in the PCICUMeghan M. Chambers, RN, QIA and Rachel Kraushaar, RN, BSN, CCRN

Pediatric Cardiac Intensive Care Unit, Monroe Carell Jr. Children’s Hospital at Vanderbilt

BackgroundThe cardiac population requires central venous access for their entire hospitalization, often months. These lines are utilized for hemodynamic monitoring, vasoactive/caustic medications, parenteral nutrition, and frequent labs. Site location is limited due to vascular abnormalities and future surgical interventions. Due to these circumstances, the health care team must be diligent in preventing central line associated blood stream infections, CLABSIs. On average each CLABSI costs $46,000 to $70,000. The PCICU is a driving force behind nurse lead initiatives that help identify, address and roll out CLABSI reduction interventions hospital wide. These include K-Cards, CHG Bathing and Coloplast barrier strips. The PCICU’s CLABSI goal is ZERO.

Outcomes/Findings• Overall CLABSI Reduction: FY18: 7, FYTD19: 4• Combination of CHG Bathing and Coloplast Barrier Strips helped eliminate and

change Pathogens• E. Coli (FY15-18 Avg: 2.5, FYTD19: 0)• Staphylococcus Aureus (FY15-18 Avg: 3.75, FYTD19: 0)• Enterococcus Faecalis (FY15-18 Avg: 5.25, FYTD19: 2)

• Increased staffing retention, Unit Median Years of Experience: 3.5-4 years

AcknowledgmentsJohn David Hughes, MMHC, BSN, RN, NE-BC

Manager, Pediatric Cardiac ICUJackie Smith, MSN, RN, CIC

Infection PreventionAndrew Harold Smith, MD MSCI MMHC

Associate Professor of Pediatrics Attending Physician & Medical Director of Cardiac ICU & Value-Based Performance

Pat Throop, BSN, RN, CPHQQuality and Patient Safety Advisor, PM&I

Sumit Pruthi, MD, MBBSChief Pediatric Neuroradiology, 3D Printing

Future Initiatives• Pilot unit for CHG Bathing in the less than 2 month population• Collaboration and involvement in creating hospital wide job instruction sheets and

videos for CVL/PICC dressing changes and accessing a CVL• Per Solutions for Patient Safety (SPS) recommendations, CHG application will be added

to CLABSI Bundle

Kamishibai Cards (K-Cards)•Hospital wide piloting unit partnering with Pediatric

Cardiology: July 2017• Standardized data collection tool to help improve

bundle compliance•Overall goal to create a culture of providing peer to

peer teaching and coaching on a daily basis• Identifies barriers and encourages ideas for

improvement• Expanded unit and hospital wide leadership

involvement in performing K-Cards• True transparency of results to help drive

accountability and improvement

Contact Information

Meghan M. Chambers, RNRegistered Nurse, Quality Improvement AnalystPediatric Cardiac Intensive Care Unitmeghan.m.chambers@vumc.org

Rachel Kraushaar, RN, BSN, CCRNRegistered Nurse, Central Line Dressing SpecialistPediatric Cardiac Intensive Care Unitrachel.kraushaar@vumc.org

Brava Coloplast Barrier StripsIts original use was for bordering ostomies, but its unique design has provided an additional layer of protection in CLABSI prevention. This easy to apply tan, see-through adhesive allows quick assessment of the dressing. The C-shape is optimal for positioning around femoral CVLs which are at high risk for contamination by urine and fecal matter. Its non-permeable and easily wipeable material helps maintain dressing integrity and minimizes CLABSI risk. Since implementing in April 2018, we have seen an elimination in E. Coli CLABSIs and an overall reduction in lower extremity CVL CLABSIs.

Challenges and ObstaclesHigh acuity patients paired with challenging staffing, travelers, EPIC rollout, less experienced staff and overall lower median years of critical care nursing experience are parallel with higher CLABSI rates, lower K-Card completion, and lower system process interventions.

CHG ApplicationChlorhexidine Gluconate 2% is a topical antiseptic application that significantly reduces the number of microorganisms on the skin. Successfully trialed for 8 months in the PCICU and PCARD prior to hospital wide rollout. Every patient with a CVL that meets criteria receives a CHG application with their daily bath.

CONFIDENTIAL INFORMATION. This information is confidential and privileged pursuant to TCA 63-1-150, and 68-11-272 et seq., and has as one of its purposes

to improve the quality and safety of patient care. Do not forward or otherwise share this information external to Vanderbilt.

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Monroe Carell Jr. Children's Hosital at Vanderbilt CLABSIs

Hospital Wide PCICU

CLABSI K-Card RolloutNew Kits & Epic Rollout

CLABSI Bl itz & CHG Bath

Coloplast & Bedside Education

Staff Meeting Dressing Education & Demonstration

Pathogen TransitionsFY15-18

FYTD19