NHSN Methodology National Healthcare Safety Network 2005 All blood cultures reviewed Line Present Known pathogen No other source of infection Common skin contaminant 2 or more Cultures SignsSymptoms ID: 787905
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Slide1
Journey to Improvement
Central Line Associated Blood Stream Infections (CLABSI)
Slide2NHSN Methodology
National Healthcare
Safety Network (2005)
All + blood cultures reviewed
Line PresentKnown pathogenNo other source of infectionCommon skin contaminant2 or more CulturesSigns/Symptoms
Slide3CLA-BSI Surveillance
Time Period: Sept 2009-Jan 2010
February 2010 One Patient (2-1-10)
PICC
7 days to infection Yeast + TPN
Slide4NCH Overall
Slide5Opportunities
ICU
and
Floors
PICCs Candida (TPN/Propofol)Enteric Organisms (Lines, dressings) Endogenous (preps)
Slide6January 2011 CLABSI Report
Infection Prevention Department
Slide7NCH CLABSI
Slide8NCH Healthcare System CLABSI
Jan 2010 thru Jul 2011
Slide9Critical Care CLABSI Rate
Slide10NCH CLABSI: Critical Care/DNH
Slide11NCH CLABSI: Critical Care/NNH
Slide12NCH CLABSI: Jan 2010 – July 2011
Slide13NCH CLABSI: Critical Care
Slide14CLABSI: Non-ICU’s Only
Slide15CLABSI: NCH System
Slide16Central line utilization above NHSN 50
th
percentile for both hospitals.
Higher risk for infection
Doing great job but it’s a matter of time…..Assess need for line daily.Critical Care CLABSI Utilization
Slide17NCH CLABSI Costs
Slide18CLABSI Analysis
Number of months WITHOUT a CLABSI
in Critical Care Units:
ICU-N > 9 months
PCU > 12 months (closed for part of time)SICU > 14 monthsICU-DTN > 23 months
CVRU > 2 years!
Number of months WITHOUT a CLABSI in all of NCH Healthcare:
2 Months in 2011 (May/Nov)
Slide19Non-ICU units have significantly decreased CLABSIs
Swab Cap trials at NNH successful and now implemented at DNH
NSG education and compliance monitoring continues to reinforce best practice
New insertion and dressing change kits implementedHigh utilization requires daily assessment for lines
CLABSI Action Plan
Slide20Sep 2009 – Jun 2011
Critical Care CLABSI/Quarter
Slide21Jan 2010 – Mar 2011
NCH CLABSI: Critical Care versus
Non-Critical
Care
Slide22The results have been through the ongoing efforts of the CLABSI Team, a multidisciplinary group lead by Dr. Doug Harrington including expertise from:
Critical Care, Infection Prevention, Education, Clinical Nurse Specialists and the IV Team.
Hard Work
Slide23Relentless execution of the following actions has resulted in significant improvements:
Monthly data feedback to the system and individual units for # of infections, causative organisms and types of lines.
The use of RCA forms to assist units with understanding the opportunities for improvement.
Action Plans
Slide24Standardization of policies and education for insertion and ongoing line care.
Education for all who care for patients with central lines.
Monitoring compliance with these policies to insure consistent execution.
Weekly feedback to the units regarding their compliance to recognize excellence and encourage improvement.
Action Plans