CLABSI: Working Toward Zero

Trinity Regional Health SystemInfection Prevention and Control

Presented by: Patricia Herath, BSN, RNCInfection Preventionist

April 20, 2010

Central Line Associated BloodstreamInfection (CLABSI) History

2006: 45 CLABSI = Rate of 7.7 per 1000 line days 2007: 9 CLABSI = Rate of 1.0 per 1000 line days

Developed Central Line Insertion Bundle 2008: 15 CLABSI = Rate of 1.9 per 1000 line days

Developed Central Line Maintenance Bundle 2009: 3 CLABSI = Rate of 0.4 per 1000 line days

Aim

Launched a focused initiative to reduce CLABSI

Zero rate was targeted using the IHI bundle check list

Initial Action Plan

Formed multidisciplinary team to track and evaluate central lines from insertion to discharge

Tracked insertion bundle compliance for Central Lines Physician champions Use of Chlorhexidine Gluconate (CHG)– prep and

biopatch Audited insertion bundle check sheets

Central lines Included PICC lines

Ramped up Hand Hygiene education

Identified Issues

Concerns related to: Although insertion bundle was followed,

additional cases were noted

o Observed non-standardized approach to line maintenance

o Identified documentation issueso Identified issues relating to maintenance

(daily care)

Additional Action Plan

In-serviced oncology office staff regarding standardized evidence based practice care Standardizing dialysis catheter dressing

changes

Developed an evidence based daily maintenance bundle for care of Central lines (April 2009)

Additional Action Plan (cont.)

Staff Education Documentation Observation of sites,

daily care and discontinuance

PICC nurses started evaluation of daily care by direct observation

Lessons learned TMC went 9 months with out a HAI – CLABSI

One in February 2010 Real time reporting to CL team with each finding

Identified possible competency issue with care of line Manager to review care with the unit’s staff

2010 Rate First Quarter= .05 Continued commitment on Director level

Disseminated throughout the entire team

Outcome

Average cost of CLABSI = $20,000

2006 – 2009 = 72 x $20,000 = $1,440,000

Reduction of costs with 0 rate

Future Direction

Evidence based standardized approach to central line blood draws

Implement program to identify patients at high risk with strategies to mitigate risk

Develop analytic committee Preventative vs. reactive

Acknowledgements

A special thanks is extended to the CLABSI team for their dedicated efforts to launch this project!

VAP: Maintaining Zero

Trinity Regional Health SystemInfection Prevention and Control

Presented by Patricia Herath, BSN, RNCInfection Preventionist

April 20, 2010

Ventilator Associate Pneumonia – (VAP) History

In first 9 months of 2006 – 13 VAPs

Developed ventilator bundle

Cost of VAPs to TRHS

Average cost of VAP: $33,887*

13 VAPs in 2006 = $440,531

Cost of product for oral care: $30.30 for 24 hours

Avoiding VAP saves $$$

*Source: CDC, Consumer Price Index (CPI) 2007 average cost

Aim

Launched facility-wide initiative to reduce VAPs

Zero rate was targeted using IHI VAP bundle

Action Plan

Formulated multidisciplinary team to reduce VAP: Unit mgr, RN staff, RT, MD champion

Initiated VAP bundle Meticulous hand hygiene HOB 30-45 degrees unless contraindicated Peptic ulcer prophylaxis Daily readiness to extubate Oral care q 2H and prn (with product at head

of the bed) and deep suctioning q 8H Also: anti embolism stockings and DVT

prophylaxis (e.g. meds, TEDS stockings)

Action Plan (cont.)

Issues identified: Received commitment from staff to

provide: oral care every 2 hours competency education

in-services on protocol and rationale target audience: physicians and nursing staff

Documentation of compliance to bundle on check list

Identified need to improve charting

Results Since October, 2006 Trinity Regional

Health System has had two VAPs Currently 26 months without a VAP

2009 – 2010: rate = 0 Staff response: great “buy in” when positive

results noted Received resistance due to cost of product

used for oral care

Any suspected cases are reviewed in real time

Huddles with Managers and unit staff Charts reviewed with Infectious Disease

physician

Rates of Healthcare Associated Infections at TRHS Compared to Hand Hygiene Compliance

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Rate of HAI per 1000 pt days HH Compliance

Results of increasing HH compliance and HAI outcomes

Acknowledgements

A special thanks is extended to the VAP team for their dedication to launch and maintain this project!

Resources

Institute for Healthcare Improvements (IHI) Improvement Project IHI is a reliable source of energy, knowledge, and

support for a never-ending campaign to improve health care worldwide. The Institute helps accelerate change in health care by cultivating promising concepts for improving patient care and turning those ideas into action. 

CDC. www.cdc.org Scott II, R.D. (March 2009). The direct medical

costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Retrieved from http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf (2010)