How University of Utah Health's Burn Trauma ICU Eliminated Central Line Infections
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Is zero possible? In the case of central line infections, the answer once was no. A CLABSI (central line associated blood stream infection) was once considered a car crash, or an expected inevitability of care. When University of Utahβs Burn Trauma Intensive Care Unit started treating CLABSIs like a plane crash, or a tragedy demanding in-depth investigation and cultural change, zero became possible. This presentation outlines the process and how to implement in your institution. To learn more, visit Accelerate: https://uofuhealth.utah.edu/accelerate/
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How University of Utah Health's Burn Trauma ICU Eliminated Central Line Infections
- 1. OUR FOUR YEAR CLABSI JOURNEY BRAD WIGGINS RN BSN BURN CENTER NURSE MANAGER @BRADWIGGINSRN @UOFUBURNCENTER
- 2. LEARNING OBJECTIVES β’ Understand the importance of teamwork to decrease line infections in your burn center. β’ Understand the importance of using a care bundle to drive line infection reduction. h t t p s : / / u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e /
- 3. h t t p s : / / u o f u h e a l t h . u t a h . e d u / a c c e l e r a t e / OUR TEAM
- 4. OUR IMPACT
- 5. SEPTEMBER 13TH, 2013 - OUR LAST CLABSI
- 6. INITIAL PLANNING β’ Hospital Infection Control Request β’ Burn Center Goal β Reduce our rate β We will always have a line infection β’ Interdisciplinary Approach β’ Created CLABSI Bundle
- 7. CENTRAL LINE CHECKLIST-PRE-PROCEDURE β’ Pre-Procedure β’ Confirm hand hygiene Β¨ β’ Fill out Universal Protocol Checklist and verify consent Β¨ β’ Review current labs and medications before time out Β¨ β’ Gather correct line tray and sterile supplies Β¨ β’ Set up Pressure Transducer System to verify any central line placement Β¨ β’ Perform a time-out with Burn Attending present Β¨ β’ MD/RN Prepare ultrasound for line placement with sterile cover Β¨ β’ Line inserter to wear: cap, mask, sterile gown/gloves, eye protection Β¨ β’ Assistant to wear: cap, mask, non-sterile gloves Β¨ β’ Check patient position before prep and drape Β¨ β’ Chlorhexidine prep with proper technique Β¨ β’ Drape in sterile fashion Β¨
- 8. CENTRAL LINE β DURING PROCEDURE β’ Maintain sterile field** Β¨ β’ Obtain qualified second operator after 3 unsuccessful attempts Β¨ β’ Aspirate blood from each lumen, connect transducer and then flush Β¨ β’ Verify placement with two view ultrasound(After guidewire placement, prior to dilation) Β¨ β’ Ask MD if IV extension or angiocath is needed for pre-dilation CVP assessment Β¨ β’ Verify placement with CVP transduction Β¨
- 10. CENTRAL LINE βPOST PROCEDURE β’ Obtain x-ray for Subclavian or Internal Jugular placement, Abd x-ray for peds. Β¨ β’ Clean site with chlorhexidine and allow to dry for 2 minutes Β¨ β’ Apply sterile dressing with labelas appropriate Β¨ β’ Document procedure Β¨ **Watch for: loss of adhesion to drape or if it moves, contamination when spreading full drape, glove contamination, guide wire contamination, contamination of field by assistant, etc.
- 11. IMPORTANT MOMENTS OF SUCCESS
- 12. CAP IT!- JUST DO IT!
- 13. DAILY ROUNDS TEAM REVIEW
- 14. DAILY NURSING ASSESSMENT β’ Wash or sanitize hands prior to accessing a patientβs IV β’ Wash patientβs hands QD with Chlorhexidine surgical scrub brush/sponge β’ Review necessity of line and indications during multidisciplinary rounds EVERY DAY
- 15. IV LINE MAINTENANCE β’ A central line dressing change is a sterile procedure β’ RN ONLY to do central line dressing change β’ IV site dressing change done every Tuesday and PRN β’ IV tubing change done every Tuesday day and Friday night and PRN (ie: Propofol) β’ Alcohol caps changed with all tubing changes β’ Alcohol caps changed on IV ports after each use of the port
- 16. RN LINE DOCUMENTATION β’ Document the dressing change and the use of Chlorhexidine for the dressing change β’ Document the line and tubing change β’ Document that patients hands were scrubbed with Chlorhexidine β’ Document Clinical Course that indications* for line were reviewed in rounds. Now in EPIC.
- 17. INDICATION FOR CVL β’ Resuscitation β’ Large Volume β’ Rapid β’ Blood β’ Hemodynamic monitoring β’ What criteria, if any? (e.g. Shock with CVP monitoring) β’ Vasopressor β’ Vasoactive drips β’ Chemotherapy, TPN, or other caustic medications (including antibiotics) β’ Transvenous pacing β’ Plasmapheresis, apheresis, hemodialysis, continuous renal replacement therapy (CRRT) β’ All peripheral access exhausted (multiple attempts, ultrasound, AirMed, midline)
- 18. UNIVERSITY HEALTH SURVEILLANCE β’ CLABSI, CAUTI, SSI and Lab ID surveillance is performed on all positive finalized microbiological results collected anywhere in both inpatient and outpatient areas utilizing TheraDoc surveillance software β’ Surveillance is performed per NHSN protocols and has been verified for accuracy by CMS and the Utah Department of Health β’ University of Utah Health has seven Infection Preventionists (IP) to perform surveillance on their assigned care areas.
- 19. 0 5 10 15 Rateper1000LineDays CLABSI Rate per 1000 Line Days4 NHSN Median BTICU
- 21. 0 50 100 150 200 250 2011 2012 2013 2014 2015 2016 2017 (Up to Sept) BloodCulturesCollected Calendar Year BTICU Blood Cultures Collected
- 22. HOW CAN YOU BE SUCCESSFUL? β’ Teamwork β MD Commitment for nursing input line status β Audits β Caps β More Audits β Culture change
- 24. JAMA β 2015