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Cluster of coagulase-negative Staphylococcus associated with central line care in the intensive care unit
E178
Vol. 33 No. 5
(RR = 1.2), and catheters not being taped to the body (RR = 1.3). Although these risk factors did not reach statistical significance due to the relatively small number of infections, they are similar to those reported in Western studies. Of special note is that the hospital with the lowest CAUTI had the best catheter care. CONCLUSIONS: CAUTI rates varied greatly among the five hospitals included in this study. Risk factors for CAUTI were fecal incontinence, incorrect catheter size, incorrect volume of water for the balloon, and insufficient catheter care. Implementation of the correct choice and use of catheters combined with good catheter care would reduce risk of CAUTI in Japanese hospitals. Abstract ID 52456 Monday, June 20
The effects of criteria-based Foley catheter guidelines in a 642 suburban hospital medical/surgical intensive care unit P Sullivan L Reilly K Williams D Fochesto Morristown Memorial Hospital, Morristown, New Jersey BACKGROUND: The critical nature of patients in an intensive care unit (ICU) makes the use of indwelling Foley catheters an inevitable ‘‘standard of care.’’ The use of indwelling Foley catheters is quite common in the hospital setting and can cause many complications. They are used in 15%–25% of all hospitalized patients. Urinary tract infections (UTIs) are the most common problem associated with their use. The risk of developing UTI, bacteriuria, and bacteremia is directly related to the length of catheterization. OBJECTIVE: The objective of this study is to investigate the appropriate use of Foley catheters in an ICU and develop guidelines that will lead to criteria-based medical reasons for their use, thus decreasing the mean Foley catheter device days as well as the variation of their use. METHODS: Based on a sample size calculation (n = 124), the pre-intervention mean Foley catheter device days in the ICU (95% confidence) was 4.72 with a standard deviation of 7.67 days. Nurse-driven surveillance was implemented using criteria-based Foley catheter (CFGC) guidelines. An algorithm for Foley catheter decisionmaking and a CFGC checklist were developed. Program was implemented following extensive education. After implementation, 83 charts were needed to review for a 95% confidence. Positive change was created by using a collaborative approach from all disciplines. Nurses, physicians, residents, management, and infection control all had a role to play. The goal was to reduce Foley catheter device days in this 22-bed mixed medical/surgical/trauma ICU. RESULTS: Six sigma techniques were used to isolate the root causes, measure capability, and define variables. After implementation of the program, the mean for device days was 2.98 and the standard deviation was 3.17 (n = 83). CONCLUSIONS: Pre-intervention, only 6% of the Foley catheters were removed before the patient was transferred out of the ICU; post-intervention, 20% of the Foley catheters were removed prior to ICU transfers, which may ultimately lead to a decrease in hospital-acquired UTIs. Abstract ID 53561 Monday, June 20
Cluster of coagulase-negative Staphylococcus associated with central line care in the intensive care unit N Church Providence St. Vincent Medical Center, Portland, Oregon
June 2005
E179
BACKGROUND: The hospital, a 451-bed acute care facility in Portland, Oregon, was alerted to a significant increase in hospital-associated coagulase-negative Staphylococcus isolates from blood sources during August-September 2003. OBJECTIVES: Identify processes putting patients at risk, correct process breakdowns, and share information for future prevention with other clinical staff. METHODS: Data-mining services are provided to the hospital. Monthly reports are generated to detect unsuspected patterns of infection within the hospital and community. In September 2003, infection control (IC) received an alert describing a 170% increase (p = 0.041) in patients with non-duplicate hospital-associated coagulase-negative Staphylococcus isolates from the blood of patients with central lines in the intensive care unit (ICU). When IC sent the pattern to the manager of critical care, the issue was presented at a staff meeting. It was discovered that a new product had been introduced (CLC2000ä from ICU Medical, Inc., San Clemente, California), and the staff was not familiar with some aspects of utilization. Addition of the CLC2000 was done to decrease heparin flushes as this product requires only saline. Equipment replacement frequency was not established, and the valve on the needleless connection did not retract when positive pressure was created. Reviewing the issues with the vendor found the instruction care card provided had missed a key step when creating the positive pressure in the access device. Interventions included updating the printed instruction cards for all nursing, re-education of the full ICU staff in the use of the CL2000, use of alcohol when swabbing all ports prior to entry, and use of ChloraPrepä for insertion and maintenance of all central lines. RESULTS: Continuing electronic surveillance for hospital-associated coagulase-negative Staphylococcus blood isolates revealed an 80% decrease by the end of January 2004. CONCLUSION: Investigation of a cluster of coagulase-negative blood isolates reduced the contaminated blood cultures and potentially the decrease of antibiotics started in response to a positive blood culture.
Abstract ID 54339 Tuesday, June 21
Development of a comprehensive surgical site infection communication plan to enhance infection control interventions MA Pass A Richards SE Cosgrove TM Perl Johns Hopkins Medical Institutions, Baltimore, Maryland ISSUE: While implementing interventions to lower rates of surgical site infection (SSI) for coronary artery bypass graft procedures (CABGs), we realized we needed a more timely way of delivering data to those that could impact these outcome measures. PROJECT: A strategy was designed to enhance communication with the cardiac surgery division. A four-pronged approach was developed to provide real time communication regarding SSIs: 1) Weekly surveillance reports to the cardiac surgery division chief (CSDC) stating the number of infections noted for the week and which SSIs will be in their calculated CABG surveillance rates. (SSIs in all types of cardiac surgery procedures are reported to the CSDC, even those that will not be used for calculating rates for CABGs.) The dean and administrative leaders of the hospital also receive weekly infection data. 2) Quarterly retrospective data of CABGs is presented along with 2 years of quarterly past data at the hospital epidemiology and infection control meeting. This information is also distributed to the nurse manager of cardiac surgery to post on the bulletin board outside the cardiac surgical rooms. Data is also sent to each surgeon and presented at performance improvement meetings.
Vol. 33 No. 5
(RR = 1.2), and catheters not being taped to the body (RR = 1.3). Although these risk factors did not reach statistical significance due to the relatively small number of infections, they are similar to those reported in Western studies. Of special note is that the hospital with the lowest CAUTI had the best catheter care. CONCLUSIONS: CAUTI rates varied greatly among the five hospitals included in this study. Risk factors for CAUTI were fecal incontinence, incorrect catheter size, incorrect volume of water for the balloon, and insufficient catheter care. Implementation of the correct choice and use of catheters combined with good catheter care would reduce risk of CAUTI in Japanese hospitals. Abstract ID 52456 Monday, June 20
The effects of criteria-based Foley catheter guidelines in a 642 suburban hospital medical/surgical intensive care unit P Sullivan L Reilly K Williams D Fochesto Morristown Memorial Hospital, Morristown, New Jersey BACKGROUND: The critical nature of patients in an intensive care unit (ICU) makes the use of indwelling Foley catheters an inevitable ‘‘standard of care.’’ The use of indwelling Foley catheters is quite common in the hospital setting and can cause many complications. They are used in 15%–25% of all hospitalized patients. Urinary tract infections (UTIs) are the most common problem associated with their use. The risk of developing UTI, bacteriuria, and bacteremia is directly related to the length of catheterization. OBJECTIVE: The objective of this study is to investigate the appropriate use of Foley catheters in an ICU and develop guidelines that will lead to criteria-based medical reasons for their use, thus decreasing the mean Foley catheter device days as well as the variation of their use. METHODS: Based on a sample size calculation (n = 124), the pre-intervention mean Foley catheter device days in the ICU (95% confidence) was 4.72 with a standard deviation of 7.67 days. Nurse-driven surveillance was implemented using criteria-based Foley catheter (CFGC) guidelines. An algorithm for Foley catheter decisionmaking and a CFGC checklist were developed. Program was implemented following extensive education. After implementation, 83 charts were needed to review for a 95% confidence. Positive change was created by using a collaborative approach from all disciplines. Nurses, physicians, residents, management, and infection control all had a role to play. The goal was to reduce Foley catheter device days in this 22-bed mixed medical/surgical/trauma ICU. RESULTS: Six sigma techniques were used to isolate the root causes, measure capability, and define variables. After implementation of the program, the mean for device days was 2.98 and the standard deviation was 3.17 (n = 83). CONCLUSIONS: Pre-intervention, only 6% of the Foley catheters were removed before the patient was transferred out of the ICU; post-intervention, 20% of the Foley catheters were removed prior to ICU transfers, which may ultimately lead to a decrease in hospital-acquired UTIs. Abstract ID 53561 Monday, June 20
Cluster of coagulase-negative Staphylococcus associated with central line care in the intensive care unit N Church Providence St. Vincent Medical Center, Portland, Oregon
June 2005
E179
BACKGROUND: The hospital, a 451-bed acute care facility in Portland, Oregon, was alerted to a significant increase in hospital-associated coagulase-negative Staphylococcus isolates from blood sources during August-September 2003. OBJECTIVES: Identify processes putting patients at risk, correct process breakdowns, and share information for future prevention with other clinical staff. METHODS: Data-mining services are provided to the hospital. Monthly reports are generated to detect unsuspected patterns of infection within the hospital and community. In September 2003, infection control (IC) received an alert describing a 170% increase (p = 0.041) in patients with non-duplicate hospital-associated coagulase-negative Staphylococcus isolates from the blood of patients with central lines in the intensive care unit (ICU). When IC sent the pattern to the manager of critical care, the issue was presented at a staff meeting. It was discovered that a new product had been introduced (CLC2000ä from ICU Medical, Inc., San Clemente, California), and the staff was not familiar with some aspects of utilization. Addition of the CLC2000 was done to decrease heparin flushes as this product requires only saline. Equipment replacement frequency was not established, and the valve on the needleless connection did not retract when positive pressure was created. Reviewing the issues with the vendor found the instruction care card provided had missed a key step when creating the positive pressure in the access device. Interventions included updating the printed instruction cards for all nursing, re-education of the full ICU staff in the use of the CL2000, use of alcohol when swabbing all ports prior to entry, and use of ChloraPrepä for insertion and maintenance of all central lines. RESULTS: Continuing electronic surveillance for hospital-associated coagulase-negative Staphylococcus blood isolates revealed an 80% decrease by the end of January 2004. CONCLUSION: Investigation of a cluster of coagulase-negative blood isolates reduced the contaminated blood cultures and potentially the decrease of antibiotics started in response to a positive blood culture.
Abstract ID 54339 Tuesday, June 21
Development of a comprehensive surgical site infection communication plan to enhance infection control interventions MA Pass A Richards SE Cosgrove TM Perl Johns Hopkins Medical Institutions, Baltimore, Maryland ISSUE: While implementing interventions to lower rates of surgical site infection (SSI) for coronary artery bypass graft procedures (CABGs), we realized we needed a more timely way of delivering data to those that could impact these outcome measures. PROJECT: A strategy was designed to enhance communication with the cardiac surgery division. A four-pronged approach was developed to provide real time communication regarding SSIs: 1) Weekly surveillance reports to the cardiac surgery division chief (CSDC) stating the number of infections noted for the week and which SSIs will be in their calculated CABG surveillance rates. (SSIs in all types of cardiac surgery procedures are reported to the CSDC, even those that will not be used for calculating rates for CABGs.) The dean and administrative leaders of the hospital also receive weekly infection data. 2) Quarterly retrospective data of CABGs is presented along with 2 years of quarterly past data at the hospital epidemiology and infection control meeting. This information is also distributed to the nurse manager of cardiac surgery to post on the bulletin board outside the cardiac surgical rooms. Data is also sent to each surgeon and presented at performance improvement meetings.