1 / 46

Evidence-Based Approaches to Elimination of Neonatal CLABSI

Evidence-Based Approaches to Elimination of Neonatal CLABSI. Janet Pettit DNP, NNP-BC, VA-BC. Disclosures . Argon Medical California Childrens Services NICU HAI Collaborative PDI. Objectives. At the conclusion of the presentation, the participant will be able to:

eydie
Télécharger la présentation

Evidence-Based Approaches to Elimination of Neonatal CLABSI

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Evidence-Based Approaches to Elimination of Neonatal CLABSI Janet Pettit DNP, NNP-BC, VA-BC

  2. Disclosures • Argon Medical • California Childrens Services NICU HAI Collaborative • PDI

  3. Objectives At the conclusion of the presentation, the participant will be able to: • Identify common components of insertion bundles used for central lines in neonates • Identify three controversial components of maintenance bundles used for central lines in neonates • List three care processes with proven efficacy in decreasing CLABSI • Distinguish two avenues beyond the insertion and maintenance bundles that have proven success in reducing and sustaining CLABSI reduction efforts

  4. California: If You’ve Seen 1 NICU, You’ve Seen 1 NICU!

  5. xxx _ ____ _ _________ _ __ _ ___

  6. Getting To Zero CLABSI! … A Believable Goal?

  7. The Results

  8. The California Journey

  9. yyy

  10. Building a Better Bundle: Sources of Evidence NICU Teams CPQCC HAI Toolkit

  11. yy

  12. x

  13. z

  14. Beyond the Basic Bundle: CCS CLABSI Prevention Bundle Elements • Insertion • Maintenance • Leadership • Diagnosis • Go to website for information about bundle http://www.dhcs.ca.gov/ProvGovPart/initiatives/nqi/Pages/default.aspx

  15. CCS CLABSI Prevention Bundle:Insertion • Maximum sterile barrier precautions • Disinfect skin withchlorhexidine or povidone iodine • Dedicated team for placement & care • All supplies for procedure at bedside • Hand hygiene performed • Insertion checklist used • Staff empowered to stop non emergent procedure if sterility breached

  16. Adopting Evidence-Based Use of CHG/Alcohol in the NICU • Barriers • Previous product labeling restricted use if < 2 months of age. • Updated product labeling January 2012: Use with care in premature infants or infants under 2 months of age. These products may cause irritation or chemical burns. • Skin reactions • Absorption • Fear of the unknown • Facilitators • Emerging evidence • Improved CLABSI reduction • Minimal reactions • Adjusting use based on gestation & chronologic age • No toxicity associated with the minimal absorption • Realization that all skin antiseptics problematic • More than half of NICUs in US are using

  17. CCS CLABSI Prevention Bundle: Maintenance Should practice extend to all lines? • Daily assessment of catheter need • Review dressing integrity & cleanliness • Use closed system for infusion, blood sampling & medication administration • Assemble & connect infusion tubing using aseptic or sterile technique. • Use consistent tubing configuration

  18. CCS CLABSI Prevention Bundle : Maintenance • Disinfect injection port with alcohol or chlorhexidine/alcohol for 15 seconds & allow to dry. • Use of alcohol port protectors • Hand hygiene performed & clean gloves worn for catheter entry • Use prefilled, flush containing syringes • Staff empowered to stop the line in non-emergent procedure if sterility breached

  19. Every day ask the question… Can the catheter be removed? • Daily assessment & documentation of catheter need – Joint Commission NPSG.07.04.01 & CA requirement • Plan for removal • Key times for removal to lessen risk

  20. Review Dressing Integrity & Site Cleanliness • PRN change recommended • Routine change intervals • Remove blood & drainage • Not intact • Use sterile technique • Dressing type • Transparent vs. gauze • Transparent: allows direct visualization and requires fewer changes, but no other demonstrated clinical advantage.

  21. Closed Systems for All Vascular Access Devices • Definition of “closed” • Infusion, blood withdrawal, med administration • Close all or only central catheters

  22. Closed Medication System • Entry point to catheter kept out of bed • Needleless connector capped with syringe at all times • System changed along with other infusion tubing Part of Aly, 2005 bundle & adopted by many NICUs

  23. Aseptic vs. Sterile Technique for Tubing Assembly • Bundle component • Aly 2005 & others • Lack of standardization • Sterile vs aseptic technique • Resource availability • 1-2 personnel • Set-up carts/stations • Consistent tubing configurations • Procedural checklist • Frequency of change

  24. Biofilm & Bacteria on External Surface of Needleless Connector Ryder et al. Microscopic Evaluation of Microbial Colonization on Needleless Connectors. 2009. APIC Poster Presentation

  25. Agents & Methods for Disinfection of Needless Connectors 31% don’t clean! Alcohol CHG/alcohol

  26. Gloves for Catheter Entry

  27. Use of Pre-filled, Flush Containing Syringes • Increase contamination of vials & ampules when prepared in ward vs pharmacy Van Grafhorst Critical Care Med 2002. • Syringe contamination • Nurse filled vs. prefilled

  28. Empower Staff to The Line

  29. Leadership Bundle

  30. CCS CLABSI Prevention Bundle: Leadership • Administrative involvement & support for zero HAIs • Engage staff with feedback • Posting days since last CLABSI • Posting rates of CLABSI • Perform investigation of each CLABSI/BSI • Surveillance activities for critical processes • Hand hygiene • Line management and entry • Off unit procedures • Stop the line support • Trained personnel to perform specialized maintenance activities

  31. Surveillance of Care Practices: Overt & Covert • Helps to ensure quality of care • Means to monitor compliance with policy • Multidepartmental personnel monitor adherence to policy • Unit-based • Hospital-based • Correct problem behavior while its occurring • Reward proper behavior

  32. Line Insertion Checklist

  33. Tubing Change Checklist

  34. Needleless Connector Checklist

  35. Monitoring Staff Performance

  36. Line Set-Up Auditing Developed by CCS CLABSI Prevention Collaborative

  37. Catheter Entry Auditing Developed by CCS CLABSI Prevention Collaborative

  38. Investigating Failure

  39. zz

  40. Getting it Right: Diagnostic Challenges • NHSN criteria • Culturing techniques

  41. CLABSI & Beyond : Other Considerations Respiratory care practices Skin assessment & # punctures # Line entries Feeding tubes & practices

  42. Supporting Continuous Improvement and Sustainability The way in which Each individual pays attention to and performs their job PLUS The way All individuals inter-relate, interact, and communicate while working, ultimately determines the sustainability of high quality, safe health care.

  43. a What will you do next week?

  44. The End Questions: jspettit@sbcglobal.net

  45. References • Chaiyakunapruk, N., Veenstra, D. L., Lipsky, B. A., & Saint, S. (2002). Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med, 136(11), 792-801. doi: 200206040-00007 [pii] • Curry, S., Honeycutt, M., Goins, G., & Gilliam, C. (2009). Catheter-associated bloodstream infections in the NICU: getting to zero. Neonatal network : NN, 28(3), 151-155. • MarschallJ., Mermel, L. A., Classen, D., Arias, K. M., Podgorny, K., & Yokoe, D. S. (2008). Strategies to prevent central line associated bloodstream infections in acute care hospitals. Infection Control and Hospital Epidemiology, 29, S22-30. • Mullany, L., Darmstadt, G. L., & TielschJ. M. (2006). Safety and impact of chlorhexidine antisepsis interventions for improving neonatal health in developing countries. Pediatric Infectious Disease Journal, 25, 665-675. • O'Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., . . . (HICPAC)., H. I. C. P. A. C. (2011). 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections 1-83. Retrieved from Centers for Disease Control and Prevention website: http://www.cdc.gov/hicpac/bsi/bsi-guidelines-2011.html • Payne, N. R., Carpenter, J. H., Badger, G. J., Horbar, J. D., & Rogowski, J. (2004). Marginal increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants. Pediatrics, 114, 348-355.

  46. References • Pettit, J. & Wyckoff, M. M. (2007). Peripherally inserted central catheter: Guidelines for practice. Glenview, IL: The National Association of Neonatal Nurses. • Powers, R. J., & Wirtschafter, D. W. (2010). Decreasing central line associated bloodstream infection in neonatal intensive care. Clinics in perinatology, 37(1), 247-272. doi: 10.1016/j.clp.2010.01.014 • Suresh, G. K., & Edwards, W. H. (2012). Central line-associated bloodstream infections in neonatal intensive care: changing the mental model from inevitability to preventability. American journal of perinatology, 29(1), 57-64. doi: 10.1055/s-0031-1286182 • Wirtschafter, D. D., Pettit, J., Kurtin, P., Dalsey, M., Chance, K., Morrow, H. W., . . . Kloman, S. (2010). A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections. [Multicenter Study]. Journal of perinatology : official journal of the California Perinatal Association, 30(3), 170-181. doi: 10.1038/jp.2009.172 • Zingg, W., Imhof, A., Maggiorini, M., Stocker, R., Keller, E., & Ruef, C. (2009). Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Critical care medicine, 37(7), 2167-2173; quiz 2180. doi: 10.1097/CCM.0b013e3181a02d8f

More Related