The C’s Are Falling
The healthcare team at The 8900 ICU, a ten-bed medical intensive care unit within Barnes-Jewish Hospital, formed an ICU multi-disciplinary committee and developed standardized educational programming as well as a daily central line checklist of best practices to ultimately reduce its central line-associated blood stream infection (CLABSI) rates.
- To reduce CLABSI in the ICU
- To educate or reeducate critical care nurses on central line assessment, maintenance and insertion practices
Reducing CLABSI rates at Barnes-Jewish Hospital became a priority in 2010 when a group of concerned ICU staff members rejected the belief that the patient population, typically adults that are immuno-compromised due to oncological complications, would naturally lead to a high rate of CLABSI. The hospital’s multi-disciplinary unit practice committee (UPC), which addresses issues impacting the delivery of patient care as well as staff and patient satisfaction, accepted the challenge of changing the ICU culture to ultimately reduce CLABSI rates.
In August 2010, the UPC appointed a team of staff nurse “champions” to complete a daily check-list for monitoring best practices in the maintenance of central line dressings. Nurse champions, as well as the advanced practicing nurse (APN) and nurse manager made daily rounds to ensure that dressings were properly changed. In addition, the committee reviewed and reinforced the hospital’s “Stop the Line” policy, requiring nurse presence throughout the line insertion process.
To ensure that all ICU staff was aware of best line insertion and maintenance practices, the hospital held a “Skills Day” to clarify optimal aseptic technique. The entire ICU team was reeducated on proper hand hygiene as well and monitored by monthly checks by a certified infection control liaison. To maintain the momentum, ICU staff developed individual dry erase boards monitoring each patient’s line information, including the dates of insertion, dressing and caps changes, to provide constant awareness of patient line maintenance.
Each month, the UPC presented the program’s results and achievements to the Clinical Practice Council, where issues impacting the practice environment are discussed and best practices are shared amongst the chairs.
90 Percent CLABSI Education: For 10 consecutive months from the start of the project, the 8900 ICU achieved a CLABSI rate of 0.28, well below the National Hospital Safety Network (NHSN) benchmark of 2.4 demonstrating an approximately 90 percent decrease in CLABSI.
- Significant improvement was evident from the 2008 and 2009 rate of 4.1, which was well above the NHSN benchmark of 2.4 and the January-July 2010 rate of 4.8, also significantly higher than the NHSN benchmark of 2.6.
ICU Team Culture Change: The 8900 ICU received full support from administrators, physicians and nursing staff.
- Nurse champions held themselves and others accountable for identifying and implementing compliance of central venous catheter maintenance.
- Nurses in the ICU were empowered to maintain their central lines from insertion to early removal, when applicable, to minimize the chance of infection. With the current ICU nursing practices in place, The 8900 ICU expects a CLABSI rate of zero for 2012.
- Maintained zero percent Clostridium difficile rate.