Peripherally Inserted Central Catheter PREVENTIVE BUNDLE Laurie Forssberg RN BSN Diana Gadek RN BSN Marlene Moreno RN BSN CRNI Christine Mueller RN BSN

PROJECT AIM The purpose of this project is identifying the rate of PICC (peripherally inserted central catheter) infections and applying a preventive bundle that would decrease the infection rate.The purpose of this project is identifying the rate of PICC (peripherally inserted central catheter) infections and applying a preventive bundle that would decrease the infection rate. Catheter related blood stream infections (CRBSI) are a major concern of the PICC team at Loyola.Catheter related blood stream infections (CRBSI) are a major concern of the PICC team at Loyola. Follow insertion guidelines and update our procedures as new evidence based practice becomes available.Follow insertion guidelines and update our procedures as new evidence based practice becomes available. Magnet Force 7: Quality ImprovementMagnet Force 7: Quality Improvement Magnet Force 8: Consultation and ResourcesMagnet Force 8: Consultation and Resources Confidential: Quality Improvement Material

Background Preventing central line infections is one of the six key strategies in the Institute for Healthcare Improvement’s (IHI’s) 5 Million lives campaign.Preventing central line infections is one of the six key strategies in the Institute for Healthcare Improvement’s (IHI’s) 5 Million lives campaign. It has been noted that CRBSI’s account for the most serious and costly of hospital acquired infections.It has been noted that CRBSI’s account for the most serious and costly of hospital acquired infections. This preventive bundle was created by utilizing the CDC’s (Centers for Disease Control) Healthcare Infection Control Practices Advisory Committee’s “Guidelines for Prevention of Intravascular Catheter-Related Infections”. Additionally SHEA/IDSA (Society for Healthcare Epidemiology of America/Infectious Diseases Society of America) Practice Recommendations “Strategies to Prevent Central Line- Associated Bloodstream Infections in Acute Care Hospitals” was used.This preventive bundle was created by utilizing the CDC’s (Centers for Disease Control) Healthcare Infection Control Practices Advisory Committee’s “Guidelines for Prevention of Intravascular Catheter-Related Infections”. Additionally SHEA/IDSA (Society for Healthcare Epidemiology of America/Infectious Diseases Society of America) Practice Recommendations “Strategies to Prevent Central Line- Associated Bloodstream Infections in Acute Care Hospitals” was used. Confidential: Quality Improvement Material

Solutions Implemented Ongoing education of team members regarding the insertion of PICC’s to assure consistent insertion guidelines are followed by all team members.Ongoing education of team members regarding the insertion of PICC’s to assure consistent insertion guidelines are followed by all team members. Practice change from a half sterile drape to a full large sterile drape.Practice change from a half sterile drape to a full large sterile drape. Continued maximum sterile barrier use with insertion: mask, cap, sterile gown and sterile gloves are utilized.Continued maximum sterile barrier use with insertion: mask, cap, sterile gown and sterile gloves are utilized. Confidential: Quality Improvement Material

Solutions cont’d Continued pre-prep: Cleansing of the patient’s arm with chlorhexidine soap and water.Continued pre-prep: Cleansing of the patient’s arm with chlorhexidine soap and water. Continued use of 2% chlorhexidine-based antiseptic for skin preparation.Continued use of 2% chlorhexidine-based antiseptic for skin preparation. Introduction of the Invision Plus Intraluminal Protection System Connector. A needle-free neutral injection cap with a straight through fluid pathway with no dead space to trap air or blood that may develop biofilm. In-service training was provided system wide.Introduction of the Invision Plus Intraluminal Protection System Connector. A needle-free neutral injection cap with a straight through fluid pathway with no dead space to trap air or blood that may develop biofilm. In-service training was provided system wide. Continued use of Stat Lock Catheter Securement Device is applied at insertion and with every dressing change.Continued use of Stat Lock Catheter Securement Device is applied at insertion and with every dressing change. Hand hygiene.Hand hygiene. Confidential: Quality Improvement Material

PICC Infection Rate Results Note: The infection rate was determined by looking at the number of PICC infections developed in hospitalized patients with lines inserted by the PICC Team. Confidential: Quality Improvement Material

PICC Line Infection Results Confidential: Quality Improvement Material

Analysis 2007: 1,573 PICCs inserted with 17 infections documented.2007: 1,573 PICCs inserted with 17 infections documented. 2008: 1,687 PICCs inserted with 14 infections documented.2008: 1,687 PICCs inserted with 14 infections documented. The rate decreased.26% from an infection rate of 1.08% in 2007 to.82% in Goal of having a less than 1% infection rate for 2008 was met. All steps in the process will be continued.The rate decreased.26% from an infection rate of 1.08% in 2007 to.82% in Goal of having a less than 1% infection rate for 2008 was met. All steps in the process will be continued. Confidential: Quality Improvement Material

Next Steps Education of staff regarding guidelines to prevent central line infections.Education of staff regarding guidelines to prevent central line infections. Consider use of chlorhexidine baths or chlorhexidine-containing sponge dressings for patient’s with PICC lines.Consider use of chlorhexidine baths or chlorhexidine-containing sponge dressings for patient’s with PICC lines. This project will be ongoing until a zero rate of infection can be reached and maintained.This project will be ongoing until a zero rate of infection can be reached and maintained. Confidential: Quality Improvement Material