Memorial Hospital’s Intensive Care Unit has gone one year without a central line associated blood stream infection (CLABSI) – an achievement earned by embracing rounding and evidence-based practice.
Physicians and nurses in the ICU have adopted a series of changes to achieve zero CLABSI infections in one year, compared to six the previous year. Among the changes: monitoring how long a central line is in place, removing central lines and replacing them with peripherally inserted central catheter lines at the earliest opportunity, and changing the products used to clean and dress the hub of the central line.
“This is the longest period we’ve gone without a central-line infection,’’ said Leighann Jock, clinical nurse specialist in the ICU at Memorial.
“Our physicians are more in tune with our efforts regarding central lines, [and] they are raising questions about whether we need to keep central lines inserted.’’
Nurse leaders believe the effort in the ICU has created a ripple effect throughout the hospital. The number of central-line infections on the floors has also been reduced – from 10 last year to two in the past 12 months.
“Before a patient transfers from the ICU to the floor, if they still have a central line, we need to know the reason why,’’ Jock said.
The majority of patients in the ICU at Memorial have central lines. Jock runs a report to determine which patients have a central line, and how long it has been in, before she rounds.
“Previously, central lines were staying in for two weeks, sometimes longer. We are focusing on getting them out as soon as we can. We’re just asking all the time: ‘Do we need the central line?’’’
Now, it is rare if a central line is left in past eight days. Many are replaced even sooner with a PICC line, which is less likely to get infected.
Dr. Patrick Faricy, chief medical officer for Memorial, said that going a year without a central line infection is a tribute to teamwork.
“Teamwork is so essential for any of these initiatives to be successful, and I mean everybody involved in patient care – physicians, nurses and techs – that’s crucial,’’ Faricy said.
“What we struggle with is hospital-acquired conditions. When people come to us, we want to discharge them better than they came in. Many of these – CLABSIs, falls, pressure ulcers, catheter-associated urinary tract infections – are things that the patient acquires in the hospital. They’re uncomfortable for the patient, prolong hospitalization and increase costs.”
“It should be paramount in our minds to prevent those things. You can get lulled into a sense that these things are inevitable because these patients are so sick, but we’ve got to get out of that mindset and strive for zero,’’ Faricy said.
In a worst-case scenario, a central-line infection can be deadly. At a minimum, patients will receive antibiotics and spend a longer time in the hospital.
The cost of a central-line infection is about $60,000, Jock said. Since the Centers for Medicare and Medicaid Services consider it a “never event,’’ the hospital is not reimbursed for the medical costs associated with such an infection.
“A central line is a very convenient thing for nurses to have. It’s widely used, and there is a tendency not to give it much thought. By looking at what best practice is and then bringing in products for nurses that are proven, I think [these changes] feel good in the unit,’’ said Suzanne James-Harmon, the ICU’s clinical nurse manager.
“The nurses are seeing the difference that their work can make in measuring something like this which, in turn, makes you open to doing more,’’ James-Harmon said.
In addition to frequent rounding, the unit made other important changes:
- Switched to a new brand of dressings that is more adhesive than previous ones.
- Head-to-toe cleansing for daily baths is now done with a product containing both alcohol and Chlorhexidine gluconate – a topical antiseptic.
- Tubing for the central line is cleansed daily from the site to the pump with the CHG product.
The unit recently celebrated their accomplishment with a breakfast of eggs, bacon, sausage, bagels, fruit, donuts and coffee. Members of the leadership team, Faricy; Kay Miller, interim chief nursing officer; Jeff Johnson, vice president of human resources; and Dan Rieber, chief financial officer, joined in the celebration.
“The staff really appreciated that,’’ James-Harmon said.