Prevention of Catheter-Related Bloodstream Infections
UMass Memorial Medical Center
Worcester, Massachusetts, USA
Team
Eric Alper MD, Patient Safety Officer
Richard Ellison III, MD, Hospital Epidemiologist
Other team members from Infection Control, Anesthesia, Critical Care, and Quality Departments
Aim
To reduce the rate of central line-related bacteremias to below the NNIS (National Nosocomial Infection Surveillance System) 50th percentile during the last quarter of FY05.
Measures
Catheter-related bloodstream infection (CR-BSI) rate per 1,000 central-line days
Changes
- Standardized central line insertion cart.
- Empowered nurses to stop procedure when deemed appropriate (policy written and approved by critical care oversight committee).
- Standardized central line catheter dressing kits to include antimicrobial patch (Biopatch).
- Standardized documentation of catheter placement on a procedure note.
- Monitored each line insertion by filling out a monitoring tool and addressing non-compliance.
- Standardized the daily assessment of continued need for central line through the use of a daily goals sheet reviewed by the multidisciplinary team on rounds each morning.
- Posted unit specific CR-BSI rate on a monthly basis.
- Educated each incoming ICU team regarding the expectation of line insertions for one unit.
- Provided weekly feedback to the ICU MD/RN staff to communicate results of bacteremia surveillance for pilot unit.
Results
Summary of Results / Lessons Learned / Next Steps
UMass Memorial Medical Center has reduced the frequency of catheter-related bloodstream infections to below the current NNIS 50th percentile. We have not yet reached our ultimate target, but we anticipate that additional focus and next steps will help us further reduce our rate of infections.
Lessons Learned:
- Track the data and communicate the results of bacteremia surveillance to unit staff.
- Ensure the central line insertion checklist is being completed. The checklist drives practice.
- Address any non-compliance noted on the line insertion checklist.
- Provide monthly education to each incoming ICU team regarding the expectations of line insertions.
- Centralize all required materials (in a dedicated line cart) to facilitate best practice.
- Work to change the culture to make it easier for nurses to speak up if best practices are not being followed. Despite clear endorsement by the managers/directors of these areas, it is still difficult for nurses to play this role.
Next Steps:
- Detailed online education that all providers must complete successfully prior to placing lines.
- Further standardization of line kits to include large drapes, chlorhexidine, and other safety equipment to make the right thing to do the easy thing to do.
Contact Information
Eric Alper, MD, Patient Safety Officer
UMass Memorial Medical Center
AlperE@ummhc.org
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