reducing clabsis by nursing driven interventions …...reducing clabsis by nursing driven...
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Reducing CLABSIs by Nursing Driven Interventions in the PCICUMeghan M. Chambers, RN, QIA and Rachel Kraushaar, RN, BSN, CCRN
Pediatric Cardiac Intensive Care Unit, Monroe Carell Jr. Children’s Hospital at Vanderbilt
BackgroundThe cardiac population requires central venous access for their entire hospitalization, often months. These lines are utilized for hemodynamic monitoring, vasoactive/caustic medications, parenteral nutrition, and frequent labs. Site location is limited due to vascular abnormalities and future surgical interventions. Due to these circumstances, the health care team must be diligent in preventing central line associated blood stream infections, CLABSIs. On average each CLABSI costs $46,000 to $70,000. The PCICU is a driving force behind nurse lead initiatives that help identify, address and roll out CLABSI reduction interventions hospital wide. These include K-Cards, CHG Bathing and Coloplast barrier strips. The PCICU’s CLABSI goal is ZERO.
Outcomes/Findings• Overall CLABSI Reduction: FY18: 7, FYTD19: 4• Combination of CHG Bathing and Coloplast Barrier Strips helped eliminate and
change Pathogens• E. Coli (FY15-18 Avg: 2.5, FYTD19: 0)• Staphylococcus Aureus (FY15-18 Avg: 3.75, FYTD19: 0)• Enterococcus Faecalis (FY15-18 Avg: 5.25, FYTD19: 2)
• Increased staffing retention, Unit Median Years of Experience: 3.5-4 years
AcknowledgmentsJohn David Hughes, MMHC, BSN, RN, NE-BC
Manager, Pediatric Cardiac ICUJackie Smith, MSN, RN, CIC
Infection PreventionAndrew Harold Smith, MD MSCI MMHC
Associate Professor of Pediatrics Attending Physician & Medical Director of Cardiac ICU & Value-Based Performance
Pat Throop, BSN, RN, CPHQQuality and Patient Safety Advisor, PM&I
Sumit Pruthi, MD, MBBSChief Pediatric Neuroradiology, 3D Printing
Future Initiatives• Pilot unit for CHG Bathing in the less than 2 month population• Collaboration and involvement in creating hospital wide job instruction sheets and
videos for CVL/PICC dressing changes and accessing a CVL• Per Solutions for Patient Safety (SPS) recommendations, CHG application will be added
to CLABSI Bundle
Kamishibai Cards (K-Cards)•Hospital wide piloting unit partnering with Pediatric
Cardiology: July 2017• Standardized data collection tool to help improve
bundle compliance•Overall goal to create a culture of providing peer to
peer teaching and coaching on a daily basis• Identifies barriers and encourages ideas for
improvement• Expanded unit and hospital wide leadership
involvement in performing K-Cards• True transparency of results to help drive
accountability and improvement
Contact Information
Meghan M. Chambers, RNRegistered Nurse, Quality Improvement AnalystPediatric Cardiac Intensive Care [email protected]
Rachel Kraushaar, RN, BSN, CCRNRegistered Nurse, Central Line Dressing SpecialistPediatric Cardiac Intensive Care [email protected]
Brava Coloplast Barrier StripsIts original use was for bordering ostomies, but its unique design has provided an additional layer of protection in CLABSI prevention. This easy to apply tan, see-through adhesive allows quick assessment of the dressing. The C-shape is optimal for positioning around femoral CVLs which are at high risk for contamination by urine and fecal matter. Its non-permeable and easily wipeable material helps maintain dressing integrity and minimizes CLABSI risk. Since implementing in April 2018, we have seen an elimination in E. Coli CLABSIs and an overall reduction in lower extremity CVL CLABSIs.
Challenges and ObstaclesHigh acuity patients paired with challenging staffing, travelers, EPIC rollout, less experienced staff and overall lower median years of critical care nursing experience are parallel with higher CLABSI rates, lower K-Card completion, and lower system process interventions.
CHG ApplicationChlorhexidine Gluconate 2% is a topical antiseptic application that significantly reduces the number of microorganisms on the skin. Successfully trialed for 8 months in the PCICU and PCARD prior to hospital wide rollout. Every patient with a CVL that meets criteria receives a CHG application with their daily bath.
CONFIDENTIAL INFORMATION. This information is confidential and privileged pursuant to TCA 63-1-150, and 68-11-272 et seq., and has as one of its purposes
to improve the quality and safety of patient care. Do not forward or otherwise share this information external to Vanderbilt.
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Monroe Carell Jr. Children's Hosital at Vanderbilt CLABSIs
Hospital Wide PCICU
CLABSI K-Card RolloutNew Kits & Epic Rollout
CLABSI Bl itz & CHG Bath
Coloplast & Bedside Education
Staff Meeting Dressing Education & Demonstration
Pathogen TransitionsFY15-18
FYTD19