Keystone ICU Study

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.

Patient safety and hospital acquired infections (HAI) are deemed highly important in the health care setting. My organization uses quality indicators pulled from EPIC, which is our health information system, to ensure we are meeting regulations for catheter associated urinary tract infections (CAUTI). Data includes rates of infections, length of foley catheter placement, reasons for foley placement, as well as facility specific documentation that is used to aide in the prevention of CAUTI. By pulling this data, one could identify trends affecting rate of infections. This may lead to a change in policy or procedure that can improve the rate of infections for those patients with foley catheters. Thus decreasing the percentage of HAI’s for

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.

NRS-433V Week 5 - Evidence-Based Practice Presentation - Healthcare Associated Infections [12 Slides + Speaker Notes]

Data definitions and the procedures used for collection will be determined by the team at the first meeting. The data will be tracked from the first day the team meets throughout the course of the quality initiative. The original goal will be to decrease CLABSI by 75% in the first year. A detailed analysis must be performed on the processes that were used to implement and maintain evidence-based practices. Each infection must have an investigational analysis completed. The data that is collected will be completely confidential so as to not break the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rules.

The IC department performs about 20 reviews a quarter utilizing the Bloodstream surveillance checklist tool to monitor for PICC/Central Line compliance. Hand sanitizer rewards are now being given to staff that has 100% in the process measure to increase CLABSI compliance. Our facility is engaged in the Hospital Improvement and Innovative Network (HIIN) formerly the Maryland-Virginia HAI Improvement Network is the hospital-wide collaborative to reduce CLABSIs. This 5-year initiative is an affiliation of the Medicare Quality Innovation Network Quality Improvement Organization for Maryland and Virginia, through Centers for Medicare & Medicaid Services (CMS). The initiative offers support efforts to improve health care quality and achieve

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

UCDMC has dropped from an “A” grade to a “B” grade starting in the Fall of 2016 to present because infection prevention performance has fallen below average (LeapFrog Group, 2017). The infection report from LeapFrog corresponds with the SNI’s infection report for 2016 and 2017. Numerous CAUTI occur in the hospital nationwide each year and costs approximately $250 million (Agency for healthcare Research and Quality [AHRQ], 2016). CAUTIs are preventable and can

CLABSI prevention is a standard of practice for those who provide care CVCs within an adult ICU and throughout the various units. However, infection rates remain high despite the care that is provided. This provides a clear need for education for those who are in direct care of those with a CVC. Utilizing the ACE Star Model, the discovery of a decrease in CLABSIs due to an education program was observed. In summary, the education program provided proper technique, antisepsis solutions, hand hygiene, and the location of insertion site significantly reduced CLABSI presence within adult ICUs. The creation of an education program as the driving force to change the current practice is to be implemented for those with direct contact of care for

CLABSI have serious consequences, impacting the patient in a variety of ways, including increased mortality, suffering, and increased length of hospitalization. Joint Commission’s national safety goals for 2016 complements IOM’s aims to provide safe care. Joint Commissions goal NPSG.07.04.01 to implement evidence-based practices to prevent CLABSI (Joint

Controlling infections in the hospital setting has been a major issue for hundreds of years. Patients have largely been effected by pathogens transferred from those appointed to care for them. Florence Nightingale became famous for changing the way we practice patient care. Her idea was simple yet powerful and it is still considered the standard worldwide. She promoted hand washing in order to reduce healthcare infections. Flash-forward a hundred years and we are now seeing infections increase through a different route. The CDC estimated about 31,100 central line associated blood stream infections occur each year (Control, 2015). According to the Centers for Disease Control and Prevention, the most commonly reported pathogens include coagulase-negative staphylococci, Staphylococcus aureus, enterococci, and Candida. (Tavianini, Deacon, Negrete, & Salapka, 2014). Although central lines was not yet a technology created in healthcare, implementing the fundamental skills as emphasized by Nightingale

The Quality Improvement nursing process that I have chosen to research is patient safety. I have chosen to focus specifically on the topic of catheter associated urinary tract infections (CAUTI’s) during hospitalization and their preventions. It is estimated that 15-25% of hospitalized patients receive a urinary catheter throughout their stay, whether or not they need it. A large 80% of all patients diagnosed with a urinary tract infection (UTI) can be attributed to a catheter (Bernard, Hunter, and Moore, 2012). The bacteria may gain entry into the bladder during insertion of the catheter, during manipulation of the catheter or drainage system, around the catheter, and after removal.