1. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. CLABSI Reduction: No Longer Just an Inpatient Initiative Jessica Vega RN, BSN Tampa, Florida

2. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. Concerns BMT patients are discharged with a central line catheter in place –Increased risk of central line – associated bloodstream infections (CLABSI). CLASBI admission for treatment may range from $35,000- 53,000 Review of literature showed lack of studies in the outpatient population In January 2009, CLABSI surveillance began in the outpatient BMT population

3. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. Data Collection Analysis of data collected over 18 months prompted nursing staff to implement a plan to decrease CLABSIs

4. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. Evidence-Based Practice and Education Nurses conducted a literature search on CLABSI reduction strategies and developed a post-insertion bundle for central line care BMT Treatment Center Nurses were educated on CLASBI, current rates, and implications for patients as well as the department

5. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. Central Line Care Perform central line dressing changes every 7days or when dressing is wet, soiled, or dislodged –Proper hand hygiene –Sterile technique –Site cleansed with antiseptic –Antimicrobial patch placed around insertion site –Caps changed with every dressing change (hub scrubbed with antiseptic) –Dressing initialed and dated with date dressing was change

6. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. Post Line Insertion Patient Education Patients are scheduled a line care education appointment immediately following line placement Education includes: – CLABSI education (patients are given a CDC CLABSI FAQ sheet) –Moffitt specific education (Moffitt Central Line Patient education handouts) Basic line care: handling line, dressing changes, flushing of catheter, when and how to safely shower with line in place, prevention and signs and symptoms of infection, when to seek medical attention

7. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. Documentation Nursing assessment and documentation: –Document date dressing was last changed or document dressing change and how it was performed –Document condition of skin and dressing associated with central line site –Assess how patient is caring for line and knowledge of CLABSI: frequency of dressing change, protection during shower, s/s of infection, proper handling/hygiene –Provide and review CLABSI FAQ sheet from CDC with every dressing change and document

8. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. Outcomes 1.6618 month pre-bundle CLABSI rate was 1.66 per 1,000 patient visits 0.8818 month post-bundle rate fell to 0.88 per 1,000 patient visits The actual number of CLABSIs fell by 30 –30 fewer hospital admissions and a minimal savings of $1,000,000 dollars to the facility

9. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc.

10. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc.

11. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. http://www.bioquell.com/technology/microbiology/staphylococcus-epidermis/ Coagulase negative staphylococci The number of coag-negative staph infections dropped from 32 pre-bundle to 7 post bundle implementation

12. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. Compliance Nursing compliance with the bundle is continuously monitored via retrospective reviews of: –Central line charting –Monthly central line audits –Review of electronic patient education tools CLABSI surveillance is ongoing with in-depth review of all CLABSIs for defects in nursing care Nursing compliance with CLABSI prevention strategies continues to be well over 90%

13. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. References Cardo, D., Dennehy, P. H., Halverson, P., Fishman, N., Kohn, M., Murphy, C. L., & Whitley, R. J. (2010). Moving toward elimination of healthcare-associated infections: A call to action. American Journal of Infection Control, 38(9), 671-675. Centers for Disease Control and Prevention, (n.d.). Checklist for prevention of central line associated blood stream infections. Retrieved from website: http://www.cdc.gov/HAI/pdfs/bsi/checklist-for-CLABSI.pdfhttp://www.cdc.gov/HAI/pdfs/bsi/checklist-for-CLABSI.pdf Centers for Disease Control and Prevention, (n.d.). FAQs about catheter-associated bloodstream infections” (also known as “central line- associated bloodstream infections). Retrieved from website: http://www.cdc.gov/hai/pdfs/bsi/BSI_tagged.pdfhttp://www.cdc.gov/hai/pdfs/bsi/BSI_tagged.pdf McHugh S.M., Corrigan M.A., Dimitrov B.D., Morris-Downes M., Fitzpatrick F., & Cowman S. (2011). Role of patient awareness in prevention of peripheral vascular catheter-related bloodstream infection. Infection Control Hospital Epidemiology, 32, 95-96 O'Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., Lipsett, P. A., & Masur, H. (2011). Guidelines for the prevention of intravascular catheter-related infections. American Journal of Infection Control, 39(4), S1-34. Safdar, N., & Mittelstadt, K. (2012). Patient awareness of the risks of central venous catheters in the outpatient setting. American Journal of Infection Control, 40(1), 80-89.

14. H. LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER – Tampa, FL 1-888-MOFFITT (1-888-663-3488) www.MOFFITT.org © 2010 H. Lee Moffitt Cancer Center and Research Institute, Inc. Thank You May I answer any questions?