1. Safer Healthcare Now Prevention of Central Line Infections The LHSC experience Feb.5, 2008 Deb McAuslan

2. CLI Prevention Teams at LHSC  Oncology and Interventional Radiology Team  CCTC Team  ICU Team

3. Prevention of Central Line Infections Insertion  Hand hygiene  Maximal barrier  Chlorhexidine 2%/70% alcohol  Optimal placement Maintenance  Daily review  Dedicated TPN line  Chlorhexidine prep  Check for inflammation with drsg changes

5. Equipment o Dressing tray or sterile towel o Sterile gloves- 1 pair o Non sterile gloves- 1 pair o 2% Chlorhexidine/ 70% alcohol swabs- 2 or more o Steri strips- 2 pkgs o Sterile transparent dressing o Primed Injection port caps o Hand sanitizer o Wash HandsY N o Position Patient appropriately to allow good visualization and access Y N o Using non-sterile gloves remove dressing with care, observe site for catheter migration. Discard dressing and gloves Y N o Assess insertion site for inflammation, redness & exudates Y N o Assess integrity of skin beneath dressingY N o Wash/ Sanitize handsY N o Cleanse site with swabs in back/forth, up/down scrubbing motion with friction Y N o Allow site to dry for at least one minuteY N o With sterile gloves apply steri stripsY N o Apply sterile transparent dressing to cover site, leaving the connection hub(s) Y N o Change capsY N o Connect tubing or lock as indicatedY N o Document procedure and observations on appropriate record Y N Essential Steps PICC Line Dressing Procedure-RN to RN Check List

7. Oncology/Radiology CLI Infections

8. CCTC Central line infections 2006- 2007

9. UH ICU CLI - 2006

10. What helped?  LHSC  Senior leadership stated their support  Communication to leadership  Resource support

11. What helped…  SHN  Trailblazer support  Toolkit, fact sheet, bibliography  Communities of practice  Audit tools

12. Key Learning's  Engagement - Compelling reason  Champions - Passion  Engage your resources  Encouragement  Don’t give up – keep momentum