1. Prevention of Central Line Infections
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
Oncology and Interventional radiology team at our Victoria Hospital campus
CCTC or Critical Care Trauma Unit
Intensive Care Unit at University Hospital.

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
The Central Line package is divided into Insertion and Maintenance components.

5. PICC Line Dressing Procedure-RN to RN Check List
Equipment
Dressing tray or sterile towel
Sterile gloves- 1 pair
Non sterile gloves- 1 pair
2% Chlorhexidine/ 70% alcohol swabs- 2 or more
Steri strips- 2 pkgs
Sterile transparent dressing
Primed Injection port caps
Hand sanitizer
Essential Steps
Wash Hands
Y N
Position Patient appropriately to allow good visualization and access
Using non-sterile gloves remove dressing with care, observe site for catheter migration. Discard dressing and gloves
Assess insertion site for inflammation, redness & exudates
Assess integrity of skin beneath dressing
Wash/ Sanitize hands
Cleanse site with swabs in back/forth, up/down scrubbing motion with friction
Allow site to dry for at least one minute
With sterile gloves apply steri strips
Apply sterile transparent dressing to cover site, leaving the connection hub(s)
Change caps
Connect tubing or lock as indicated
Document procedure and observations on appropriate record
On our oncology unit we implemented a central line dressing procedure check list .
Spot audits were done with dressing changes at the bedside.
This allowed us to gather information that could isolate problems with technique, knowledge and compliance. We found that some staff were not familiar with the new technique of scrubbing with friction, the chlorhexidine with added alcohol.
Posters were placed on the unit to give quick reference as to “What’s Hot & What’s Not in Central Lines”
Data was collected for a minimum of 5 dressing changes per month- the audits covered all four units on our floor – new and senior staff were all audited
Hickman/Perm catheters had separate checklist

7. Oncology/Radiology CLI Infections
It was our Oncology team that felt they had a problem with infection rates and because their population is at such high risk, they wanted to improve. The Coordinator of this area, Kate Fournie approached me and asked if they could be involved. Almost exclusively their central lines are started in Interventional radiology. She connected with her counterpart in Interventional Radiology, Mary Jayne Bambury who agreed to be part of the team. This was our only team to have control over both components.

8. CCTC Central line infections 2006-2007
When we approached the critical care units, they were concerned that they were not able to control the insertion component and they felt most of their central lines were started outside their unit. They also felt they would not get good compliance from the ever changing resident pool that work there. They also felt they did not have time to do the audits. Plus, they did not feel that this was a big problem in their areas and they were meeting the NIS average in Canada and that they had multiple bigger practice issues that needed their attention that they had teams working on.
We looked at CCTC and where lines were being started. From Oct-Dec/05 – approx. 56% of lines were inserted in CCTC, 15% in the OR, 9% in Radiology, 9% in ER, 7% in other hospitals, some unknown. They agreed to implement the bundles, but not participate in auditing.

9. UH ICU CLI
ICU at UH were already had incredibly low rates and it took me awhile to realize they truly had very low rates. They felt that this intervention would not benefit them much for all the effort of implementation, but did agree to implement the protocols.

10. What helped? LHSC Senior leadership stated their support
Communication to leadership
Resource support
It is essential to have Senior Leadership stand and announce that this project is supported. This is an acute care teaching hospital. Our teams are continually working on best practice initiatives. The difficulty is which ones can areas support as all this work demands resources, either in people or supplies.
Getting the message out. Having this project presented at our Leadership Forum for all to hear by our Trailblazer, Project Lead made sure people were aware of it.
We are fortunate at LHSC to have a lot of resources to help with data - Our infection control team collected the infection rates. Our Quality Performance people collected the no. of pts per month per area and identified those under 18. What has been the most difficult was counting line days. This fell to the Coordinators and was a grueling daily task to count. We have moved to adding this to our Workload measurement data sheet, but are now concerned that we may have lack of compliance in completion of this data.

11. What helped… SHN Trailblazer support Toolkit, fact sheet, bibliography
Communities of practice
Audit tools
Mary Anne Davies, our Trailblazer has kept encouraging us and problem solving when times got tough.
The Toolkit and fact sheets helped as we went to to engage teams. The bibliography was essential, as team now demand to know the research recommendations are based on.
The communities of practice have been helpful in looking for solutions, but most of all, to reassure me that we were not the only ones struggling to find our way.
The audit tools were a helpful starting place to develop tools for our teams.

12. Key Learning's Engagement - Compelling reason Champions - Passion
Engage your resources
Encouragement
Don’t give up – keep momentum
Teams have multiple demands on their time – all want to give good care. There are lots of best practices to be worked on. Why should they choose this initiative now? Need to see this as a priority to be motivated – must make the case if not their idea
One passionate person to lead the charge makes all the difference. Kate was that passionate person. The Oncology population are so immunosuppressed, it was obvious what devastation sepsis can impact outcomes.
Multiple departments pulling together to make this happen
Infection Control
Professional Practice
Management and leadership
Quality Performance
Risk Management
Front line nurse and physician teams