Central Line Infections A BIG Problem for Little People

What are the Issues Lines predispose our vulnerable population to infection Infection rates have not improved for our <1000gms population despite introducing our revised line management in Sept 06 Central line infections in the <1000gm population account for 70% of our line infections

Assessment and Evaluation of the Problem Nurses rush to change fluids by 7 pm, therefore increasing the possibility of contamination Identified inconsistency in line care practice Difficult and time consuming line care process currently in situ Knowledge deficit-new, float, and agency staff, even old staff need reminders, too!

What do we do NOW? Meticulous hand hygiene Review information on CLAVE and “scrub the hub” procedures and apply it to practice Scrupulous line changing technique Half of the TPN lines will be changed before 7pm, the other half between 7pm and 11pm…decreasing the rush Streamline the line change process thus eliminating the “buddy-system” Practice modification regarding the process of these central line changes will be introduced

What YOU can do to help Communicate, Communicate, Communicate! Ask if the line could be discontinued if not necessary During staff rounds, suggest advancing feeds for those babies who are tolerating feeds Monitor infections, evaluate your practice, and believe in the power of one!

What do we do now?

Our Problem Solving Solution PLAN Our problem is the sustained increase in central line infection rates for our LBW population Review of the process identified several issues: nurses are hurried in the line change process, lines remain in place beyond need, current technique is a time consuming and in-depth process Review clave and “scrub the hub” allowing us to streamline the line tubing change process to one that is less intricate but still remains safe for our clients Introduce new tubing and central line tubing change process

Our Problem Solving Solution Do Institute new tubing change process and simplified technique Educate staff as to why the new process is necessary and what we hope to accomplish with the new and “improved” line change process Train staff on new line change procedure and tubing

Our Problem Solving Solution Check Gather data regarding infection rates after instituting new procedure and tubing Consider employee feedback regarding the new tubing and process Monitor compliance with new tubing usage and line change technique

Our Problem Solving Solution Act Act upon newly collected data-increase or decline in line infections Revise procedure as needed Educate and reeducate as necessary Adopt improved process as central line change culture

Why has our line infection rate remained high? Policies People Work-arounds Too many steps Knowledge-deficit Overkill Non-compliant with change Evidence-based? Why has our line infection rate remained high? Not labeling lines Environmental congestion Reuse of flush syringes Equipment restrictions require more frequent than necessary line changes Complex steps therefore Not done properly Lack of partner due to busy unit Plant Procedure