Implementation of a Vascular Access Team to Reduce Central Line Usage and Prevent Central Line-Associated Bloodstream Infections

2019 ◽  
Vol 42 (4) ◽  
pp. 193-196 ◽  
Author(s):  
Thomas J. Savage ◽  
Amanda D. Lynch ◽  
Stacey E. Oddera
Keyword(s):  
Vascular Access ◽  
Bloodstream Infections ◽  
Central Line

scholarly journals 806. Decreasing Central Line-associated Bloodstream Infections Through Quality Improvement Initiative on a High Acuity Transplant Unit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S446-S446
Author(s):  
Katie Ip ◽  
Leah M Shayer ◽  
susan m lerner ◽  
Leona Kim-Schluger ◽  
Jang Moon
Keyword(s):  
Best Practices ◽  
Vascular Access ◽  
Best Practice ◽  
Infection Prevention ◽  
Bloodstream Infections ◽  
Central Line ◽  
Quality Improvement Initiative ◽  
Vascular Access Devices ◽  
High Acuity ◽  
Clabsi Rate

Abstract Background Central line-associated blood stream infections (CLABSI) have a significant impact on mortality, morbidity and length of stay. Data collected by the Infection Prevention Department revealed progressive increases in the rate of CLABSI on an Abdominal Transplant Unit. Recognizing a drift from best practice, front line staff, the IP team and vascular access specialists, collaborated to identify opportunities for improving care of patients with vascular access devices. Methods An increase in CLABSI rate was observed on the Abdominal Transplant Unit beginning in 2016. An initiative began in 2017 to evaluate whether CLABSI rate reduction was sustainable for at least 1 year and to identify key determinants of this sustainability. Interventions were aimed at infection prevention best practices, care standardization, and team-based monitoring. Interventions included (1) re-education on CLABSI reduction, (2) two RN dressing changes to validate practice during central line dressing change, (3) blood draws from central lines (during non-emergent situations) had to be approved by nurse manager, physician lead and transplant quality physician, (4) CLABSI prevention nurses were chosen as designated phlebotomists for patients with prior approval, (5) daily line review was performed to address line days, indication of line (remove latent lines) and plan of care (transition to permanent access) and this information was shared with the unit physician lead and transplant quality team. Assuring compliance with audits and timely feedback with clinician accountability were vital with compliance with best practices. Results Conclusion During the intervention, CLABSI infection rates dropped from 4.825 to 1.533 in 1,000 CVC days. The sustainability plan for this program is to continue line audits, assessing line necessity and review the effectiveness of the initiatives, review all new CLABSI data with staff and implement new changes as necessary. Joint, ongoing multidisciplinary collaboration is essential to reduce CLABSIs and optimize quality in a challenging, high-acuity patient population. Disclosures All Authors: No reported disclosures

scholarly journals Adverse Events Associated With Midline Vascular Catheters

2020 ◽  
Vol 41 (S1) ◽  
pp. s114-s114
Author(s):  
Richard Hankins ◽  
Nicholas Lambert ◽  
Mark Rupp ◽  
Terry Micheels ◽  
Elizabeth Lyden ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Vascular Access ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Quality Improvement Initiative ◽  
Vascular Access Devices ◽  
Access Device ◽  
Vein Thrombosis ◽  
Vascular Access Device

Background: Central-line–associated bloodstream infections (CLABSIs) result in increased patient morbidity. Guidelines recommend against peripheral venous catheters when access is required for longer than 6 days, often leading to central venous catheter (CVC) placement. To improve vascular access device choice and reduce the potential risk of CLABSI, we implemented a quality improvement initiative comprised of a vascular access algorithm and introduction of a midline vascular access device (MVAD). We report complications associated with MVAD use including deep vein thrombosis (DVT), thrombophlebitis, and BSI. Methods: A prospective quality improvement assessment from October 2017 through March 2018. All MVADs were monitored for DVT, thrombophlebitis, and BSI. Insertion time and removal of MVAD were tracked, as well as presence of other vascular access devices. Results: From October 2017 through March 2018, 858 MVADs were inserted in 726 different patients, yielding 3,588 MVD days. In total, 6 primary BSIs occurred in patients with MVADs. In patients with only a MVAD, the rate was 0.72 BSI per 1,000 MVAD days, whereas patients with an MVAD as well as a CVC had a rate of 1.98 per 1,000 MVAD days. The overall CLABSI rate at the institution during this period of time was 1.24 per 1,000 CVC days. Also, 29 cases of thrombophlebitis occurred, for a rate of 3.84 per 1,000 catheter days in patients with only an MVAD compared to 4.63 per 1,000 catheter days in patients with an MVAD and a CVC. Also, 25 DVTs occurred during this time, resulting in a rate of 2.88 per 1,000 catheter days in patients with only an MVAD and 4.63 per 1,000 catheter days in patients with multiple vascular-access devices. A significant correlation was noted between MVAD indwell time and BSI (P = .0021) and thrombophlebitis (P = .0041). The median indwell time for patients experiencing BSI was 16.17 days ± 8.04 days, whereas the median indwell time for patients experiencing thrombophlebitis was 9.24 days ± 7.99 days. Conclusions: The implementation of a vascular-access algorithm including MVAD may effectively reduce CVC insertions and BSIs. The rate of BSI in MVAD was below that of CLABSI during the assessment period. Known complications associated with MVAD include DVTs and thrombophlebitis, which correlates with the duration of catheterization, and these risks appear to be further compounded in patients requiring multiple devices for vascular access. Further research into comparing the risk of vascular access of MVAD with CVC is warranted.Funding: NoneDisclosures: None

Unnecessary Removal of Central Venous Catheters in Cancer Patients with Bloodstream Infections

2018 ◽  
Vol 39 (2) ◽  
pp. 222-225 ◽  
Author(s):  
Anne Marie Chaftari ◽  
Ray Hachem ◽  
Sammy Raad ◽  
Ying Jiang ◽  
Elizabeth Natividad ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Cancer Patients ◽  
Vascular Access ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Central Venous Catheters ◽  
Infect Control Hosp ◽  
Physician Education ◽  
Central Venous

We evaluated the rate of central venous catheter (CVC) removal in 283 cancer patients with bloodstream infections (BSIs). Removal of CVCs occurred unnecessarily in 57% of patients with non-central-line-associated BSI (non-CLABSI), which was equivalent to the rate of CVC removal in patients with CLABSIs. Physician education and safe interventions to salvage the vascular access are warranted.Infect Control Hosp Epidemiol 2018;39:222–225

scholarly journals Impact of Expansion of Vascular Access Team on Central-line–Associated Bloodstream Infections

2020 ◽  
Vol 41 (S1) ◽  
pp. s260-s260
Author(s):  
Carolyn Holder ◽  
Elizabeth Overton ◽  
Sarah Kalaf ◽  
Doris Wong ◽  
Jill Holdsworh ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Best Practices ◽  
Healthcare System ◽  
Vascular Access ◽  
Task Force ◽  
Bloodstream Infections ◽  
Central Line ◽  
Radiology Department ◽  
Full Time ◽  
Healthcare Associated Infection

Background: Through participation in a system-wide healthcare-associated infection-reduction task force, we leveraged our ability to standardize best practices across hospitals in a university-owned healthcare system to reduce central-line–associated bloodstream infection (CLABSI) rates. Methods: Our multidisciplinary team had representation from all hospitals in our healthcare system. The team benchmarked practices in place and compared CLABSI standardized infection ratios (SIRs). One hospital had a robust vascular access team (VAT) and consistently low CLABSI SIRs; expanding and standardizing VAT across the hospitals in the system became the primary goal of the team. We developed a business case to justify VAT expansion that considered savings from decreasing CLABSIs and benefits to interventional radiology revenue by decreasing PICC insertion and comparing costs for added full-time equivalents (FTEs). CLABSI rates before and after VAT team expansion at 2 large hospitals were compared to the hospital with existing robust VAT. Other process improvement activities were implemented across all hospitals. The expanded VAT assumed responsibility for central-line maintenance, promoted removal of unneeded lines, expanded education efforts, and enhanced capacity for insertions. Results: The VAT expansion from 5.4 FTEs to 15.9 FTEs at 2 large hospitals (1,100 total beds) began in April 2017 and was phased over ~6 months. CLABSI SIRs for the 15 months preceding expansion were compared to the SIRs for the 15-month period after expansion for the 2 hospitals with expanded VAT (hospitals A and B) and for hospital C with preexisting robust VAT (Table 1). We observed a 33% decrease in PICC insertions in interventional radiology department in hospitals A and B. Overall return on investment (ROI) estimates using lower and upper cost per CLABSI ranged from a loss of $156,000 to a net gain of $623,000. Conclusions: A significant decrease in CLABSI rates temporally related to expansion of VAT occurred in 2 hospitals, whereas the hospital with existing robust VAT demonstrated a modest decrease in CLABSI rates. We were able to demonstrate a favorable ROI from the VAT expansion without an impact on HAC penalties. Using the model of standardizing best practices across a system and creative ROIs may help justify the addition of scarce resources.Funding: NoneDisclosures: None

Summary of Evidence-Based Practices for Bloodstream Infection Prevention Across the Health Care Continuum of Care for Vascular Access Clinicians: Addressing the 3 Common Sources of Health Care-Associated Infection Transmission

2016 ◽  
Vol 21 (2) ◽  
pp. 72-74 ◽  
Author(s):  
J. Hudson Garrett
Keyword(s):  
Health Care ◽  
Vascular Access ◽  
Infection Prevention ◽  
Critical Role ◽  
Bloodstream Infections ◽  
Central Line ◽  
Infection Prevention And Control ◽  
Evidence Based ◽  
Clinical Environment ◽  
Core Element

Abstract Infection prevention and control is a core element of patient safety and in the reduction of central line-associated bloodstream infections. These deadly infections can cause a mortality rate of approximately 12%–25% in inpatient populations. Bloodstream infections can in many cases be prevented through the adoption of evidence-based standards from organizations such as the Centers for Disease Control and Prevention and the Association for Vascular Access. Vascular access professionals play a critical role in infection prevention in patient care by practicing frequent hand hygiene, maintaining a clean and sanitary clinical environment of care, and performing proper skin antisepsis before the insertion of a vascular access catheter. Each of these interventions contributes to the overall goal of eliminating central line-associated bloodstream infections in these very vulnerable patients.

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