1. Central Line Infections
A BIG Problem for Little People

2. 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

3. 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!

4. 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

5. 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!

6. What do we do now?

7. 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

8. Our Problem Solving SolutionDo
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

9. 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

10. 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

12. 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