Saint Francis Hospital CLBSI Tennessee Patient Safety Initiative August 28, 2008 Terri Stewart MSN, RN Saundra Jirik MSN, RN
Do We Have a Problem? Too many central line infections Identified infections were a maintenance issue Femoral lines inserted in emergent situations
Do We Have a Problem? Large number of PICC lines inserted Multiple types of line kits in hospital Handwashing practices High risk populations: Sickle Cell
Do We Have a Problem? Lack of Bundle Compliance by physicians Education issues: Current staff and Agency staff
Do We Have a Problem? High risk populations: Sickle Cell Lack of Bundle Compliance with physicians Education issues: Current staff and Agency staff
Do We Have a Problem? Central Lines
Do We Have a Problem? Quit Blaming someone else I’m the problem
Plan of Action Developed Central Line Task Force- multidisciplinary -- Root Cause Analysis Housewide education of Nursing Staff Save the Line Campaign Line Audits
Plan of Action Nurses empowered to stop Physicians if not following Bundles Developed Checklist Femoral Lines changed in 24 hours Line Alert Developed PICC Criteria
Plan of Action Patient Education Sheet Customized dressing kits Shared Line Audit results /BC results with staff Eliminated blood draws from central lines
Getting to Zero Involved staff in solution Unit analysis of (+) blood cultures TEGO for Dialysis lines
Getting to Zero Scrub the Hub Campaign with Chlorhexadine Handwashing Focus PICC insertions in Radiology
Where are we Now? 83% reduction in CLI in ICU 65.6% reduction in CLI housewide