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Needleless Access Disinfection Standardization Improves Compliance and Decreases Central-line Associated Infections Within Pediatric and Neonatal Intensive Care Units
Methods: A sequential convenience sample of midline patients, encompassing 158 patients receiving maximal sterile barrier protection and 152 patients receiving partial-body sterile barrier protection. Patients assessed for “suspected” and “confirmed” catheter infection. Patient comfort and ease of use were qualitatively assessed. Results: Both groups were well-matched for age and severity of illness. There were no confirmed catheter-related bloodstream infections in either group. There were 8 suspected catheter infections in the maximal sterile barrier group: all with either other defined sources of infection and/or negative blood cultures. There were 3 suspected catheter infections in the partial-body sterile barrier group: none of these were confirmed. Limitations: Relatively small sample size; lack of randomization. A large scale randomized controlled trial is needed. Conclusions: When using an all-in-one midline, with enclosed guidewire and no MST-type exchanges, the use of a partialbody sterile barrier appears non-inferior to maximal sterile barrier protection with respect to incidence of catheter infection. Additionally, the partial-body sterile barrier resulted in less patient anxiety and enhanced clinician-inserter productivity.
Medical Device Adverse Event Reporting. What’s My Role? Linda Burns The purpose of this abstract is to focus on the importance of reporting adverse events related specifically to medical devices related to vascular access. Although it is very important to report adverse events in many categories, I am focusing only on vascular access in this abstract. The methods and process of reporting will be discussed and demonstrated. The limitations that we as clinicians have in reporting will also be discussed. The goal at the conclusion of this abstract is that the clinician will see the importance, necessity and accountability that we have to report adverse events.
Needleless Access Disinfection Standardization Improves Compliance and Decreases Central-line Associated Infections Within Pediatric and Neonatal Intensive Care Units Deborah Quast, Belinda Bordeaux Background: Pediatric and neonatal intensive care units at our large community children’s teaching center were not utilizing standard products or practices for disinfection of needleless access sites before every access. Isopropyl alcohol pads, alcohol chlorhexidine pads, alcohol embedded scrub devices, and alcohol cap devices were used in combinations or alone but differently between these units. Low or high rates of infection were defended by each unit’s unique practices or patients. Purpose: Utilize a lean quality approach to determine and implement best products and practices to maintain a goal of zero central line infections across the continuum of care.
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Vol 21 No 4
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Project: Intravenous administration observations revealed different practices for disinfection of needleless access sites within the units. The neonatal unit used an alcohol chlorhexidine swab for hub cleansing and the pediatric unit had an isopropyl alcohol swab or an alcohol embedded scrub device. Observations showed inconsistent practices: scrub, no scrub, or a swipe between accesses. Using quality methods to determine best practice, a 3.15% chlorhexidine gluconate/70% isopropyl swab with a 5 second scrub/5 second dry was implemented prior to every port/hub access. The neonatal unit was motivated to keep it, but collaboration was new for both units. A published success story provided product value to the pediatric unit. The neonatal and pediatric intensive care units reached zero infections during the trial period and have maintained zero or near zero infections for several months after implementation of new product and practice change. Implications: An educated and collaborative team approach across the continuum of care can improve outcomes with innovative product and practice changes. Standardizing products with value and education can reduce vascular related infections among diverse patients. Conclusion: Using a non-confrontational approach for evaluating processes, understanding the value of different practices and products, and initiating collaborative improvements can reduce central-line infections to zero in vulnerable patient populations.
Nurse Specialization Joshua Levendorf Background: Our Hospital has a vascular access specialty program, PICC team. The present team consists of four registered nurses. The team began their nursing careers on various units within the hospital. Prior to joining the PICC team all nurses were STAT nurses. Purpose: This papers’ purpose is to look at the transition of a nurse into a specialized role as a PICC nurse. At present the PICC team places approximately 2000 PICC lines a year. At present the PICC team consists of one senior nurse who has been with the PICC team for over 10 years and three new PICC nurses. Project Description: Nurse led PICC programs around the country and world have traditionally been taught by physicians. Our program is nurse lead. Through our training and orientation we have both didactic and clinical learning from an established set of policies based on evidence based- practice and competencies. Implications: The role of a PICC nurse is by definition a nurse specialist. The transition from bedside nursing to the role of a PICC nurse indicates greater depth of knowledge and a more focused look at the patient taking into account the factors and variables involved in selecting the appropriate access device, appropriate time of placement and identifying inappropriate patient populations. Results: A new component to our continuing education is an ongoing learning assessment tool. This component is chart audits and chart reviews. This allows for quality improvement in the program and for documentation. To the new PICC nurse
2016
Medical Device Adverse Event Reporting. What’s My Role? Linda Burns The purpose of this abstract is to focus on the importance of reporting adverse events related specifically to medical devices related to vascular access. Although it is very important to report adverse events in many categories, I am focusing only on vascular access in this abstract. The methods and process of reporting will be discussed and demonstrated. The limitations that we as clinicians have in reporting will also be discussed. The goal at the conclusion of this abstract is that the clinician will see the importance, necessity and accountability that we have to report adverse events.
Needleless Access Disinfection Standardization Improves Compliance and Decreases Central-line Associated Infections Within Pediatric and Neonatal Intensive Care Units Deborah Quast, Belinda Bordeaux Background: Pediatric and neonatal intensive care units at our large community children’s teaching center were not utilizing standard products or practices for disinfection of needleless access sites before every access. Isopropyl alcohol pads, alcohol chlorhexidine pads, alcohol embedded scrub devices, and alcohol cap devices were used in combinations or alone but differently between these units. Low or high rates of infection were defended by each unit’s unique practices or patients. Purpose: Utilize a lean quality approach to determine and implement best products and practices to maintain a goal of zero central line infections across the continuum of care.
254
j
JAVA
j
Vol 21 No 4
j
Project: Intravenous administration observations revealed different practices for disinfection of needleless access sites within the units. The neonatal unit used an alcohol chlorhexidine swab for hub cleansing and the pediatric unit had an isopropyl alcohol swab or an alcohol embedded scrub device. Observations showed inconsistent practices: scrub, no scrub, or a swipe between accesses. Using quality methods to determine best practice, a 3.15% chlorhexidine gluconate/70% isopropyl swab with a 5 second scrub/5 second dry was implemented prior to every port/hub access. The neonatal unit was motivated to keep it, but collaboration was new for both units. A published success story provided product value to the pediatric unit. The neonatal and pediatric intensive care units reached zero infections during the trial period and have maintained zero or near zero infections for several months after implementation of new product and practice change. Implications: An educated and collaborative team approach across the continuum of care can improve outcomes with innovative product and practice changes. Standardizing products with value and education can reduce vascular related infections among diverse patients. Conclusion: Using a non-confrontational approach for evaluating processes, understanding the value of different practices and products, and initiating collaborative improvements can reduce central-line infections to zero in vulnerable patient populations.
Nurse Specialization Joshua Levendorf Background: Our Hospital has a vascular access specialty program, PICC team. The present team consists of four registered nurses. The team began their nursing careers on various units within the hospital. Prior to joining the PICC team all nurses were STAT nurses. Purpose: This papers’ purpose is to look at the transition of a nurse into a specialized role as a PICC nurse. At present the PICC team places approximately 2000 PICC lines a year. At present the PICC team consists of one senior nurse who has been with the PICC team for over 10 years and three new PICC nurses. Project Description: Nurse led PICC programs around the country and world have traditionally been taught by physicians. Our program is nurse lead. Through our training and orientation we have both didactic and clinical learning from an established set of policies based on evidence based- practice and competencies. Implications: The role of a PICC nurse is by definition a nurse specialist. The transition from bedside nursing to the role of a PICC nurse indicates greater depth of knowledge and a more focused look at the patient taking into account the factors and variables involved in selecting the appropriate access device, appropriate time of placement and identifying inappropriate patient populations. Results: A new component to our continuing education is an ongoing learning assessment tool. This component is chart audits and chart reviews. This allows for quality improvement in the program and for documentation. To the new PICC nurse
2016