2. The Institute for Healthcare Improvement’s
Central Line Bundle was implemented in our
intensive care unit at Rush-Copley Medical
Center
Goal of zero not obtained
Quality collaborative established in 2008
◦ IV Therapy Coordinator/Nurse Educator and
Infection Control
3. Deficit Reduction Act - February 8, 2006
◦ Reduce expenditures for “reasonably preventable”
diagnosis by implementing EBP guidelines (Graves &
McGowan, 2008)
◦ Zero tolerance for CLABSIs (Graves & McGowan, 2008)
Centers for Medicare and Medicaid – October
1, 2008
◦ Discontinued reimbursement for CRBSIs
◦ (Graves & McGowan, 2008)
6. Hand hygiene
Insertion site and
dressing
management
Cap care
Flushing protocol
Daily monitoring
of all IV catheters
Develop policies and procedures based on Evidence
7. Inconsistent practice was noted
Dressing labels were absent
Multiple dressing changes were necessary
due to ineffective dressing securement
CHG impregnated patch was placed upside
down 75% of the time
Improper training for negative pressure valve
caused clotted lines
Breaks in aseptic technique identified
12. CLABSI Rate
◦ Review each CLABSI episode for
specific issues and preventable
causes
◦ Provide feedback and education for
staff who charted on a line that
resulted in a CLABSI.
13. Central line associated infections per 1000
catheter line days:
July 2007-June 2008: 1.27 infections
Median rate for all central lines in critical care units is
1.8 – 5.3 per 1000 catheter days (Harnage, 2007)
July 2008-June 2009: 0.51 infections
July 2009-June 2010: 0.45 infections
July 2010-June 2011: 0.00 (no infections)
15. Practice protocols must be followed at all times
Prompt identification of individual CLABSI episodes
with prompt intervention to the specific individuals
involved have been shown to be cost effective and
can be implemented into most hospitals
(Collignon, et al., 2007).
Layered kit design increases aseptic technique
compliance
Efficacious products play an important part in getting
to zero
Process changes are important parts of the puzzle.
Empowering staff through education that increases
knowledge, understanding and skills will improve
patient safety and patient outcomes.
16. Berenholtz, S. M., Pronovost, P. J., Lipsett, P. A., Hobson, D., Earsing, K., Farley, J.
E., Milanovich, S., Garrett-Mayer, E., Einters, B. D., Rubin, H. R., Dorman, T. &
Perl, T. M. (2004). Eliminating catheter-related bloodstream infections in the
intensive care unit. Critical Care Medicine, 32 (10), 2014 – 2020.
Collignon, P. J., Dreimanis, D. E., Beckingham, W.D., Roberts, J. L. & Gardner, A.
(2007). Intravascular catheter bloodstream infections: An effective and sustained
hospital-wide prevention program over 8 years. Medical Journal of Australia, 10
(19), 551 – 554.
East, D. & Jacoby, K. (2005). The effect of a nursing staff education program on
compliance with central line care policy in the cardiac intensive care unit. Pediatric
Nursing 31, (3), 182 – 184.
Graves, N. & McGowan, J. E. (2008). Nosocomial infection, the deficit reduction act
and incentives for hospitals. Journal of the American Medical Association, 300
(13), 1577 – 1579.
Harnage, S. A. (2007). Achieving zero catheter related blood stream infections: 15
months success in a community based medical center. Journal of the Association
for Vascular Access, 12 (4), 218 - 223.
Warren, D. K., Zack, J. E., Mayfield, J. L., Chen, A., Prentice, D., Fraser, V. J. &
Kollef, M. H. (2004). The effect of an education program on the incidence of
central venous catheter-associated bloodstream infection in a medical ICU.
Chest, 126, 1612 – 1618.