Clabsti Research Project Response

Identification of infections is reviewed during the quarterly ICU meeting during Q&A sessions for potential VAEs, IVACs, possible and probable VAPs. All events will be reflected in the statistical reporting data individually.

Catheter related bloodstream infections are not only responsible for prolonged hospital stays and increased hospital costs, it is also responsible for increased mortality of the hospitalized patients. According to Centers for Disease Control and Prevention (2017), an estimate of 30,100 central line-associated bloodstream infections (CLABSI) occur in intensive care units and wards of U.S. acute care facilities each year. CLABSI is a serious hospital-acquired infection that occurs when bacteria enters the bloodstream through central venous catheters. CLABSI is preventable as long as health-care personnel practice aseptic techniques when working with the catheter. A blood culture swabbed from the tip of the catheter is needed to confirm the

In 2013, a magnet recognized hospital, Baptist Health Lexington, reduced CAUTI rates in ICU patients by 60% (Roser, Piercy & Altpeter, 2014). The study included six interventions that were followed by the staff in the effort to reduce CAUTI. The six interventions included: “communication of CAUTI data to interdisciplinary teams, a nurse-driven, physician approved protocol, problem analysis using Lean principles, daily unit-based surveillance rounds, silver alloy urinary catheters, and an antimicrobial bundle comprised of two cleansing products for patients with an indwelling urinary catheter” (Roser, Piercy & Altpeter, 2014). The nurse-physician protocol allowed for nurses to assess whether the catheter was still necessary and if found not to be, the nurse could discontinue it. This resulted in a 58% decrease in the number of catheters used (Roser, Piercy & Altpeter, 2014). An education session was implemented by nurses using principles from the Lean system that checked the capability of nurses to understand just how dangerous CAUTI can be. It was found that no single intervention alone could reduce the occurrence of CAUTI development. Nurses must integrate several interventions to have an effective result at lowering the rates. However, this particular study found that after the use of the antimicrobial bundle, rates of CAUTI did decline. Roser et al. (2014) emphasized that education and awareness of

National Patient Safety Goals (NPSGs), established in 2002 by the Joint Commission, is to help accredited organizations address specific areas of concern in regard to patient safety ("Catheter-Associated," 2015). NPSG.07.06.01 Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI) is a 2015 NPSG ("The Joint Commission," 2015). Our facility has 1.32 CAUTIs per 1000 device days (Carson, 2015). Decreasing CAUTIs can be achieved with a strict goal, addressing the financial implications, interdisciplinary collaboration, nursing leadership, a measurement tool, and discussing the future healthcare delivery methods.

Getting an infection from improper care during or after insertion of a central line is the last thing you want to get while in the hospital. This paper will discuss Kaiser Permanente’s policy on central venous catheter, also known as a central line, care and dressing change, and whether it follows the current evidence-based practice on preventing bloodstream infection in patients who have them inserted. I will explain about what a central line is, why evidence-based practice is important in the clinical setting, what Kaiser Permanente’s policy about central line care and dressing change is, if Kaiser is currently following evidence-based practice based on current articles about preventing central line associated bloodstream infections (CLABSIs), and what my role in using evidence-based practice is as a future registered nurse.

Article by Clancy (2009) explained central lines were a result of an estimated 250,000 blood stream infections and accounted for 30,000 to 62,000 patient deaths, then adding that each infection cost upwards of $36,000 and cumulatively add up to at least $9 billion in preventable costs annually. The article also explains how the mindset has changed from the cost of having a central line in place and expecting complications to lowering infection rates by an intentional interventional process/s. The article speaks of 5 basic steps to reduce CLABSI, hand washing, insertion techniques, skin cleansing, avoidance of certain sites and earlier removal of the CVC. Studies showed that these guidelines were only followed 62% of the time. The system was changed to ascertain that all the clinicians were in compliance. This prompted 5 interventions, education, a CVC insertion cart with all necessary equipment, physicians having to validate central line necessity, a concise checklist for bedside clinicians and the empower of nurses to stop procedures if guidelines were not followed. These low cost interventions from 11.3/1000 in catheter days in 1998 to zero in the fourth quarter of 2002.

Internal Processes * Qualify for a Patient Centered Medical Home (PCMH) * Communications – (entire staff) – with a quarterly staff meeting * Improve comfort levels with ICD-10 diagnosis coding

The purpose of this initiative is to decrease and/or eliminate central line-associated bloodstream infections (CLABSI) in the neonatal intensive care unit (NICU) at Aurora Bay Care Medical Center. Hospital acquired infections, including CLABSI, is a major cause of mortality, prolonged hospitalization, and extra costs for NICU patients (Stevens & Schulman, 2012). The goal of this initiative is to decrease CLABSI by 75% by reducing the number of days lines are in and standardizing the insertion process and line maintenance.

These guidelines provide nurses with the most up to date regulations to keep their patients safe. Some of the guidelines include; with the administration of all medications or blood products the nurse should use two patient identifiers (such as name, DOB, MRN, and blood band), label all medications and solutions to reduce or eliminate medication errors, and prevent hospital acquired infections by providing Foley care, central line care, performing hand hygiene, etc.(“National Patient Safety Goals,”2015).

A two-year program called On the CUSP: Stop BSI was formulated in 2008 to prevent CLABSIs in hospitals nationwide and was organized as a state or region-level collaborative with centralized education, data collection, and program management functions (AHRQ, 2012). More than 1,000 hospitals and 1,800 hospital units, representing a total of 44 states, the District of Columbia, and Puerto Rico, participated in the program (AHRQ, 2012). The program structure included three main components: (1) a model to translate evidence into practice at the bedside to prevent CLABSIs; (2) the CUSP to improve the safety culture; and (3) a system to measure and report infection data (Sawyer et al., 2010). Results of the program revealed success in reducing CLABSIs nationwide by 41% from a baseline of 1.915 infections per 1,000 line days to a rate of 1.133 infections (AHRQ, 2012). With the nationwide success of the On the CUSP: Stop BSI program (AHRQ, 2012), the state of Hawaii embarked on their own study to determine if a national ICU collaborative to reduce CLABSIs would succeed in the state (Lin et al., 2012). The study, which began in January 2009 and ended in December 2010, included the CUSP, a multifaceted intervention approach to CLABSI prevention, and infection rate monitoring (Lin et al., 2012). Data was collected and reported from 20 ICUs representing 16 hospitals across the state (Lin et al., 2012). The results revealed the overall mean 9statewide CLABSI rates decreased 61% from 1.5 infections per 1,000 catheter days at baseline to 0.6 at 16 to 18 months post-implementation of the project, reinforcing the evidence that the On the CUSP: Stop BSI program can succeed in other states and substantially reduce CLABSI rates in hospitals (Lin et al., 2012). The success of the initial Hawaii study was the catalyst to conduct a second study in the state. This cohort study continued the national On the CUSP: Stop BSI program interventions, extended

The use of disinfecting Curos™ caps must be a routine practice on all oncology floors. This change can readily be implemented, as it does not take much training to learn how to use. The Curos™ caps should also be implemented already existing CLABSI prevention bundles. Considering the 12-25% high mortality rates of CLABSI, implementing the disinfecting caps could reduce the rates of CLABSI by as much as 66% (Whitfield& Lowe, 2013). According to Ramirez, Lee, & and Welch(2014) “ During 2010,the CLABSI rate reduced from 1.9 to 0.5 per 1,000 catheter days during a one-year trial period. Furthermore, compliance to CLABSI prevention bundles increased from 63% to 80% when implementing the disinfecting Curos ™ caps. This high

In 2008, CMS implemented policy through the Affordable Care Act that links quality to payment in an effort to produce better patient outcomes and decrease healthcare expenditures. The CMS policy includes pay-for-performance incentives and non-payment for HACs and readmissions. The problem with this policy is that recent data suggests there are no significant changes in central catheter-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), or ventilator-associated pneumonia after the implementation of the policy. There is also the issue of unreliable reporting of HACs through the use of Medicare severity diagnosis related groups (MS-DRGs) and present on

My work placements acknowledge the importance of these skills and have programmed professional development training modules for every week. The next training module is on health and safety. This is important because nurses interact with patients for a longer time than the physicians. Basically, the training will incorporate aspects such as risk assessment, risk management and the process of reporting these assessments (Shannon, 2012).

Furthermore, in a study by Vyas, Ongari, Hou, & Ali (2016), the purpose was to determine CDI in 1000 PD and the utilization of broad spectrum antibiotics (BSA) before and after the implementation of the ASP. The study was designed as an interventional, retrospective analysis and the sample consisted of 763 adult patients in three different university hospitals over a nine months period. The patients were separated into one group before the implementation of the ASP and second group after the implementation of the ASP that received BSA. The study noted that the risk of acquiring CDI is increased with the over use of BSA, therefore with the implementation of the ASP in hospitals, there has been a reduction in the rate of hospital-acquired

Because SSI rates for healthcare facilities are made public, patients are able to gain knowledge of how well their facility SSI prevention practices work. “It is moving fast and furiously because consumers are pleased with the progress that has been made in reducing central line infections,” says Linda Greene, MPS, RN, CIC, director, infection prevention, Rochester General Health System, Rochester, New York. The public now expects the same transparency for SSIs” (Patterson, P., 2011) .Facilities that participate in Medicare must report their SSI for certain procedures; the list of procedures to report continues to grow as patients’ demand for listed procedures grow. ” SSI data will be reported through the National Healthcare Safety Network (NHSN) managed by the Centers for Disease Control and Prevention (CDC), a secure, web-based surveillance system for reporting data on infections and other events. The data can then be used for analysis, facility comparisons, and quality improvement.” (Patterson, P., 2011) Hospitals will, and should, continuously search for new ways to increase their quality of care. Having a great overall rating for a low number of incidences of SSIs can only boost their ratings.