744 A Quality Improvement Project on Timely Removal of Central Venous Catheters

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Devarakonda ◽  
P J Korula ◽  
S Kandasamy
Keyword(s):  
Online Survey ◽  
Blood Stream ◽  
Central Line ◽  
High Morbidity ◽  
Alert System ◽  
Improvement Project ◽  
Central Lines ◽  
Surgical Icu ◽  
Intervention Adherence ◽  
The Mean

Abstract Introduction Central Line-Associated Blood Stream Infections are associated with high morbidity and mortality. It is essential to ensure quality in insertion, maintenance, and timely removal of central lines. Our ICU follows a protocol to remove unused lines after five days. We have an electronic alert system to monitor these lines, and we wanted to audit its usage and improve its efficacy. Method This project was designed using QI methodology and was carried out in a Level III Surgical ICU. We implemented two PDSA cycles in August and December 2020. After the first cycle, an online survey was performed among ICU doctors to gauge their knowledge of the alert system and local protocols. Based on the above results, an educational session was carried out, showing a step-by-step guide to using the alert system, and a re-audit was done in December. Results The first cycle showed that alerts were created for only 17 (25%) of 68 lines. Also, the survey revealed that about 30% of doctors were unfamiliar with the alert system. After the intervention, adherence to the alert system increased to 65% (alerts for 41 of 63 lines). There was also a significant improvement in the mean number of central line days from 6.4 (SD = 3.1) to 4.2 (SD = 2.8) [P <  .05]. Conclusions It is crucial to monitor central lines, and simple educational sessions about local protocols can bring success in implementing sustainable change in quality. We suggest hospitals have systems to monitor the central lines and regularly audit their effectiveness.

scholarly journals 1040 Evaluation of The Use of Biopatch In Haemodialysis Lines: Are We Reducing the Risk of Infection?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Win ◽  
D Banerjee ◽  
J Deng ◽  
N Fraser
Keyword(s):  
Clinical Evidence ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Electronic Records ◽  
High Morbidity ◽  
Risk Of Infection ◽  
Central Venous ◽  
The Mean ◽  
The Cost

Abstract Aim Children who had the central venous lines inserted for prolonged vascular access usually experience the catheter-related blood stream infection (CRBSI). CRBSI is known to be associated with high morbidity which increases the cost of the healthcare and the chances of mortality. Clinical evidence suggests that the use of biopatch (chlorhexidine-impregnated dressing) is effective in reducing the rate of infection in central venous lines. The aim of our study was to evaluate whether the use of biopatch actually reduced the CRBSI in children who had had haemodialysis lines at our institution. Method Theatre logs and electronic records of 46 patients who had haemodialysis lines inserted between 2015-2019 were retrospectively reviewed. These patients were randomly selected. Results The total number of lines inserted in 46 patients were 104. The mean of line per patient was 2.2. Out of 104 lines, 22 lines (21%) had confirmed infection. Conclusions Infection of the central line is still a significant problem. Infections were more prevalent in cases which did not use biopatch according to the documentation. We believe the rate of infection can be reduced by encouraging the use of biopatch on regular basis for the haemodialysis lines and the proper documentation of its use in the operation notes.

The Line Snuggler: A Central Line Bundling Innovation Evaluated in a High-Risk Pediatric Population

2020 ◽  
Vol 38 (1) ◽  
pp. 36-41
Author(s):  
Marybeth Tetlow ◽  
Deborah Allen ◽  
Angel Barnes ◽  
Ryan J. Shaw
Keyword(s):  
Online Survey ◽  
Pediatric Population ◽  
Quality Care ◽  
Blood Stream ◽  
Central Line ◽  
Marrow Transplant ◽  
Post Intervention ◽  
Central Lines ◽  
High Satisfaction ◽  
Increased Risk

Central line associated blood stream infections and complications in children require prevention strategies related to both traditional childhood activities as well as adverse events in the intensive care unit or bone marrow transplant unit. This study evaluated a nurse-invented product, the Line Snuggler, designed to protect intravenous tubing and central lines from contamination or entanglement. Patients ( n = 30) were enrolled following the chemotherapy phase of transplant. Using a pre–post intervention design, each subject served as their own control for the control phase of the study (Days 1-3 without a Line Snuggler) and the intervention phase (Days 4-6 with a Line Snuggler), with bacterial levels of product and sheets tested on Days 1, 3, 4, and 6. At study conclusion, staff ( n = 44) and parents/guardians ( n = 25) completed an online survey assessing satisfaction with the product, and perceived utilization and safety. Using t tests, the Line Snuggler bacterial levels showed no difference in growth in adenosine triphosphate levels compared with the same patient’s sheets, thereby supporting no increased risk of bacterial growth. Both staff and parents/guardians reported high satisfaction with their use of the Line Snuggler and noted the benefit of its protecting and bundling intravenous lines into a single organizer. This innovative product designed by nurses was evaluated as a means to provide exceptional, high-quality care to achieve the best outcomes while eliminating hospital-acquired complications ( https://www.linesnugglers.com/ ).

scholarly journals Reduction of Central-Line–Associated Bloodstream Infections in a Spinal Cord Injury Unit

2020 ◽  
Vol 41 (S1) ◽  
pp. s370-s370
Author(s):  
Stephanie L. Baer ◽  
Amy Halcyon Larsh ◽  
Annalise Prunier ◽  
Victoria Thurmond ◽  
Donna Goins ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Patient Population ◽  
Bloodstream Infections ◽  
Central Line ◽  
Fiscal Year ◽  
Improvement Project ◽  
Central Lines ◽  
Cord Injury ◽  
Bundle Compliance

Background: Central-line–associated bloodstream infections (CLABSIs) are a complication of indwelling central venous catheters, which increase morbidity, mortality, and cost to patients. Objective: Due to increased rates in a spinal cord injury unit (SCIU), a performance improvement project was started to reduce CLABSI in the patient population. Methods: To reduce the incidence of CLABSI, a prevention bundle was adopted, and a peer-surveillance tool was developed to monitor compliance with the bundle. Staff were trained to monitor their peers and submit weekly surveillance. Audits were conducted by the clinical nurse leader with accuracy feedback. Bundle peer-surveillance was implemented in February of 2018 with data being fed back to leadership, peer monitors, and stakeholders. Gaps in compliance were addressed with peer-to-peer education, changes in documentation requirements, and meetings to improve communication and reduce line days. In addition, the use of an antiseptic-impregnated disc for vascular accesses was implemented for dressing changes. Further quality improvement cycles during the first 2 quarters of fiscal year 2019 included service-wide education reinforcement, identification in variance of practice, and reporting to staff and stakeholders. Results: CLABSI bundle compliance increased from 67% to 98% between February and October 2018. The weekly audit reporting accuracy improved from 33% to 100% during the same period. Bundle compliance was sustained through the fourth quarter of 2019 at 98%, and audit accuracy was 99%. The initial CLABSI rates the quarter prior to the intervention were 6.10 infections per 1,000 line days for 1 of the 3 SCIUs and 2.68 infections per 1,000 line days for the service overall. After the action plan was initiated, no CLABSIs occurred for the next 3 quarters in all SCIUs despite unchanged use of central lines (5,726 line days in 2018). The improvement was sustained, and the line days decreased slightly for 2019, with a fiscal year rate of 0.61 per 1,000 line days (ie, 3 CLABSIs in 4,927 central-line days). Conclusions: The incidence of CLABSI in the SCIU was reduced by an intensive surveillance intervention to perform accurate peer monitoring of bundle compliance with weekly feedback, communication, and education strategies, improvement of the documentation, and the use of antiseptic-impregnated discs for dressings. Despite the complexity of the patient population requiring long-term central lines, the CLABSI rate was greatly impacted by evidence-based interventions coupled with reinforcement of adherence to the bundle.Funding: NoneDisclosures: None

scholarly journals Effect of early versus standard central line removal on growth of very low birthweight premature infants: a protocol for a non-inferiority randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030167
Author(s):  
Justyna Romańska ◽  
Wojciech Margas ◽  
Renata Bokiniec ◽  
Paweł Krajewski ◽  
Joanna Seliga-Siwecka
Keyword(s):  
Preterm Infants ◽  
Premature Infants ◽  
Low Birthweight ◽  
Intervention Group ◽  
Central Line ◽  
Optimal Time ◽  
Control Group ◽  
Very Low Birthweight ◽  
Central Lines ◽  
The Mean

IntroductionUncertainty exists regarding the optimal time for removal of central lines used to provide parenteral nutrition in preterm infants. The aim of this study is to determine whether earlier central line removal is non-inferior to its removal after reaching full enteral intake, in respect to growth outcome of preterm infants.Methods and analysisVery low birthweight premature infants will be recruited. Eligible infants will be randomised in equal proportions between two groups. In the intervention group central lines will be removed when infants reach 100 mL/kg/day of enteral intake. In the control group central lines will be removed when infants reach 140 mL/kg/day of enteral intake (full enteral intake). The primary outcome measure will be the difference between the two groups in weight at 36 weeks’ postmenstrual age. Non-inferiority will be declared if the mean weight of children in the intervention group will be no worse than the mean weight of children from the control group, by a margin of −210 g.Ethics and disseminationThe Bioethics Committee of the Medical University of Warsaw approved the study protocol prior to recruitment. The findings of this trial will be submitted to a peer-reviewed journal (neonatology, paediatrics or nutrition). Abstracts will be submitted to relevant national and international conferences.Trial registration numberNCT03730883.Protocol versionVersion 3. 14.08.2019.

Central Line Associated Blood Stream Infections in Pediatric Hematology/Oncology Patients With Different Types of Central Lines

2016 ◽  
Vol 63 (9) ◽  
pp. 1603-1607 ◽  
Author(s):  
Jeffrey D. Hord ◽  
John Lawlor ◽  
Eric Werner ◽  
Amy L. Billett ◽  
David G. Bundy ◽  
...  
Keyword(s):  
Blood Stream ◽  
Central Line ◽  
Oncology Patients ◽  
Blood Stream Infections ◽  
Central Lines ◽  
Pediatric Hematology ◽  
Different Types

782 Central Line Associated Blood Stream Infection Reduction Utilizing a Business Improvement Model: The Four Disciplines of Execution

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S225-S225
Author(s):  
Elizabeth Dale ◽  
Grace Schmits ◽  
Karen Allard
Keyword(s):  
Blood Stream Infection ◽  
Time Consistency ◽  
Blood Stream ◽  
Central Line ◽  
Dramatic Improvement ◽  
Improvement Project ◽  
Improvement Rate ◽  
Team Members ◽  
Healthcare Improvement ◽  
And Performance

Abstract Introduction In July of 2018, the Burn ICU had very high Central Line Associated Blood Stream Infection (CLABSI) rate, more than double national rates. Due to the high cost and mortality associated with CLABSI, the unit leadership initiated a quality improvement project to decrease CLABSI rates. Methods The process implemented is called the “Four Disciplines of Execution” (4DX) based on a book by Sean Covey. Those methods are as follows: Results The 4DX Process allowed identification of areas for all team members (MDs and RNs) to improve their practice. Over time, consistency of practice with lead measures became 100% and new lead measures had to be developed. CLABSI improvement rate exceeded expectations; in June the rate dropped to 2.29 infections per 1000 patient line days (only 1 CLABSI during intervention period). Conclusions This process allowed engagement of the whole team, allowed for MD and RN problem solving and accountability, and resulted in dramatic improvement in HAI rates in the Burn ICU. Applicability of Research to Practice This method was unique compared to typical healthcare improvement models. In addition to being effective, it helped improve overall morale and performance on the unit.

scholarly journals 1168. Trends in Central-Line-Associated Blood Stream Infections in a Community Teaching Hospital: A Multi-Intervention Quality Improvement Project

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S418-S418
Author(s):  
Abraham Wei ◽  
Ronald Markert ◽  
Christopher Connelly ◽  
Hari Polenakovik
Keyword(s):  
Quality Improvement ◽  
Teaching Hospital ◽  
Medical Condition ◽  
Central Line ◽  
Improvement Project ◽  
Central Lines ◽  
Improvement Interventions ◽  
Quality Improvement Interventions ◽  
The Impact ◽  
Community Teaching

Abstract Background Central line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality as well as increased medical costs. We sought to describe the impact of various quality improvement interventions on the incidence of CLABSI in a large 990-bed community teaching hospital from the period of January 1, 2013 to December 31, 2017. Methods Retrospective study of CLABSI events as defined by the CDC’s National Healthcare Safety Network was completed. Between 2013 to 2017, we introduced mandatory real-time root cause analysis for each CLABSI event to identify defects that could be used for quality improvement interventions. We implemented a bundle of interventions for proper central venous catheter (CVC) insertion and maintenance based on CDC recommendations and the results of the internal analysis. Interventions included utilizing chlorhexidine gluconate (CHG) skin preparation and maximum sterile barrier precautions, optimal site selection (avoiding femoral site), using antimicrobial-coated CVCs and antithrombotic Bioflo peripherally inserted central catheters (PICC), minimizing multi-lumen CVC and PICC use, de-escalating CVC to midline or preferential use of midline catheters while minimizing unnecessary PICC and CVC insertion, adding Curos disinfection caps on central lines and other vascular access sites, weekly scheduled CVC site dressing changes with Tegaderm CHG I.V. Securement Dressing, CHG baths for patients with CVCs, avoidance of blood culture draws from central lines, and daily review of line necessity with timely removal. Medical staff members received ongoing education on the implementation of the CLABSI bundle. Both ICU and non-ICU CLABSI cases in the adult patient population were analyzed. Results A comparison of 2013 with 2017 shows a 69% decline in a number of CLABSI cases from 36 to 11 patients (Figure 1). There was a 30% decline in CVC days from years 2014 to 2017 (No CVC days data for 2013 due to change in data collection system). Over the same period, CLABSI events per 1,000 CVC days decreased from 0.624 to 0.362 (Figure 2)—a 42% decline. Conclusion Study findings show that our comprehensive bundle of interventions for CVC insertion and maintenance resulted in decreased rates of CLABSI. Disclosures All authors: No reported disclosures.

572 Integrating Shared Governance Principles with Real-time Technology to Improve Infection Rates in a Large Burn Center with Patients of Varying Acuity Levels

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S136-S137
Author(s):  
Jane Echols ◽  
Ashley Gamble ◽  
Lisa Berry ◽  
Lynn Dowling ◽  
Michael Wheeler
Keyword(s):  
Nursing Education ◽  
Real Time ◽  
Best Practice ◽  
Shared Governance ◽  
Central Line ◽  
Retention Rates ◽  
Infection Rates ◽  
Time Data ◽  
Improvement Project ◽  
Central Lines

Abstract Introduction Increased job satisfaction, and nursing retention are outcomes that have been related to nursing empowerment.1 Probably one of the most beneficial results of nursing empowerment is improved patient outcomes.1 Empowering nurses is not always an easy task, but the nursing best practice of shared governance through unit-based councils gives nurses the ability to mobilize resources within their own groups to get things done. Couple this mobilization of resources with real-time technology that provides a true clinical picture of outcomes, and this creates a template for success. Methods This is a nursing Quality Improvement project. Shared governance in the form of unit-based councils created within all of our patient care units has proven to be part of the equation for improved infection rates in all units. Our number of CAUTI AND CLABIS from 2018–2019 were reduced, we significantly reduced the number of device days (hospital-wide) for both foleys and central lines, which was also a goal. Through extensive nursing education, utilizing nurse driven protocol for foley removal, increased use of bladder scanning (each unit now has their own bladder scanner) and teaching about de-escalation of central lines/PICC lines as soon as possible, we have been able to reduce our device days overall. Alongside this nursing best practice, a new nursing data portal that allows for real time data collection to identify breaks in protocol with regards to central line and foley maintenance leading to CAUTIs and CLABSIs was also implemented, which allowed nursing to have direct impact on achieving success. Results Percent Change 2018 – 2019 CAUTI BU = 83% decrease, 3E burn = 100% decrease, 4W burn = 100% decrease Overall decrease = 90% CLABSI BU = 85%, 3E burn = 67% increase, 4W burn = no change Overall decrease = 78% Conclusions Implementation of nursing best practice efforts such as shared governance and unit-based councils, coupled with cutting edge technological resources directly contribute to improved infection rate outcomes. Another result of these efforts is the overall positivity fostered among nursing staff, boosting their sense of empowerment and creating better retention rates in all our units.

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