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Reducing Central Line-associated Blood Stream Infections Through Expert Practice
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Poster Abstracts / American Journal of Infection Control 45 (2017) S16-S93
next site. This study describes qualitative analysis of barriers to implementation. METHODS: We conducted monthly conference calls with facilitators at four VA hospitals in multiple patient care settings. Notes were taken during calls chronicling factors to implementation. We utilized a Human Factors Engineering (HFE) tool, the Systems Engineering Initiative for Patient Safety (SEIPS) model for categorizing the barriers into 5 work systems: Person, Organization, Tools and Technologies, Tasks and Environment. Content analysis of notes identified categories and themes. RESULTS: A common barrier to implementation among the VA sites was readiness at all levels of the organization—facility level, unit level and individual staff level. Themes identified include 1) Costs (e.g., concern for CHG product cost), 2) Resources (e.g., staffing levels, time per patient), and 3) Staff preferences (e.g., use of CHG versus standard soap). CONCLUSIONS: Infection preventionists often encounter organizational barriers during implementation of infection control interventions. An essential first step before embarking on moving evidence to practice may be to thoroughly assess readiness at all levels of the organization. One such tool is the Organizational Readiness for Change Assessment (ORCA) developed and utilized by the VA that assesses organizational readiness for implementation of a specific, evidence-based clinical practice.
Session EPOP-154 12:30-1:30 p.m. Reducing Catheter Associated Urinary Tract Infections in the Adult Intensive Care Setting through Implementation of Catheter Rounds and Infection Alerts Kelsey Wick, MPH, Infection Preventionist, United Hospital, part of Allina Health; Jennifer Barry, BSN, RN, Patient Care Supervisor, Children’s Hospitals and Clinics of Minnesota; Christopher Allen, BSN, RN, CCRN, CNRN, Nurse Clinician, United Hospital, part of Allina Health; Mark Chlebeck, MSN, MBA, Patient Care Manager, University of Minnesota Physicians; Aimee Nelson, BSN, RN, CCRN, Patient Care Manager, United Hospital; Rebecca Siebenaler, BSN, RN, CCRN, Patient Care Manager, United Hosptial, part of Allina Health BACKGROUND: A higher incidence than expected of Catheter Associated Urinary Tract Infections (CAUTI) was occurring on a 14 bed Neuro Intensive Care Unit (ICU) and a 31 bed Medical/Surgical ICU within a 350 bed-hospital. There was no standard for ensuring best practices were applied for patients with an indwelling urinary catheter (IUC), nor were CAUTI details relayed to staff upon occurrence. To decrease CAUTI and increase awareness of prevention efforts, IUC rounds were initiated by an Infection Preventionist (IP) and nurse leaders on both units several times a week and CAUTI alerts were sent to nursing staff as an infection was identified. METHODS: Beginning in June 2014, an IP and ICU nursing leaders developed a plan to increase CAUTI awareness by implementing IUC rounds. IUC rounds included assessing the reasons for IUC along with visually assessing for elements of best practice. Rounding provided opportunity for feedback and education on maintenance practices, and necessity of IUC in real time. CAUTI alerts were shared with staff and included likely causes of infection following a thorough chart review and highlighted the best practices for preventing CAUTI.
RESULTS: Within one year of implementation of IUC rounds and CAUTI alerts there was a 57% decrease in CAUTI in the Med/Surg ICU, and a 33% decrease in CAUTI in the Neuro ICU. CAUTI and IUC rounding data was reported to staff monthly, providing an opportunity to highlight areas to focus improvement work. CONCLUSIONS: Through routine IUC rounds and real-time feedback as CAUTI occurred, the awareness of CAUTI increased amongst the health care team. In this setting, nurses have the opportunity to ask questions with IPs and nursing leaders, and often lapses in best practices are corrected early on aiding in infection prevention efforts. IPs participating with IUC rounds helped foster relationships with nurses and increased collaboration beyond CAUTI improvement initiatives.
Session EPOP-155 12:30-1:30 p.m. Reducing Central Line-associated Blood Stream Infections Through Expert Practice Franklin Benjamin, BSN, RNLatonya McCoy, RN, Infection Prevention, Florida Hospital; Tiffany Richens, MS, MPH, CIC, Infection Prevention-Project Manager/Educator, Florida Hospital; Vincent Hsu, MD, MPH, CIC, FSHEA, FACP, Hospital Epidemiologist, Florida Hospital; Suzanne Denza, BS, Quality Analyst, Infection Prevention, Florida Hospital BACKGROUND: Oncology patients are a distinct population requiring additional needs. Due to their immunocompromised status, central line associated blood stream infection (CLABSI) rates among Oncology patients are higher among the general inpatient population. In December 2015, an Oncology service line identified an increase in CLABSI rates specifically stemming from poor care and maintenance and realized a change in practice was necessary. METHODS: A standardized toolkit was developed based on the results of a root cause analysis and needs assessment of the staff through discussion and observation. The toolkit included a preassessment of the unit needs, an education plan, process implementation and revalidation of the process. The education was designed from the pre-assessment needs of the staff and focused specifically on care and maintenance of central lines, dressing changes, assessment of the dressing for risk of infection and checkoff on these skills. Upon completion of education, leadership implemented processes that audited central lines closely and began the two-person dressing change system described in the toolkit. Interdisciplinary rounds which included physicians, nurses, and infection prevention focused on line necessity and care were also implemented. Three months after initiation of the toolkit, the units began the revalidation process by leadership assessing the care and maintenance process of each staff member. RESULTS: The post intervention data was analyzed in March, 2016 after the completion of the education phase. There was a significant decrease in the CLABSI rates during that same time period (Pvalue = .044). This accounted for a 64% decrease in CLABSI rates. There was also a significant decrease in the device utilization rate (DUR) of central lines when comparing June 2015-February 2016 to March 2016-November 2016 (P-value <.001). CONCLUSIONS: A multidisciplinary development of a standardized toolkit that enhanced care and maintenance resulted in a significant decrease in CLABSI rates in the Oncology units.
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017
Poster Abstracts / American Journal of Infection Control 45 (2017) S16-S93
next site. This study describes qualitative analysis of barriers to implementation. METHODS: We conducted monthly conference calls with facilitators at four VA hospitals in multiple patient care settings. Notes were taken during calls chronicling factors to implementation. We utilized a Human Factors Engineering (HFE) tool, the Systems Engineering Initiative for Patient Safety (SEIPS) model for categorizing the barriers into 5 work systems: Person, Organization, Tools and Technologies, Tasks and Environment. Content analysis of notes identified categories and themes. RESULTS: A common barrier to implementation among the VA sites was readiness at all levels of the organization—facility level, unit level and individual staff level. Themes identified include 1) Costs (e.g., concern for CHG product cost), 2) Resources (e.g., staffing levels, time per patient), and 3) Staff preferences (e.g., use of CHG versus standard soap). CONCLUSIONS: Infection preventionists often encounter organizational barriers during implementation of infection control interventions. An essential first step before embarking on moving evidence to practice may be to thoroughly assess readiness at all levels of the organization. One such tool is the Organizational Readiness for Change Assessment (ORCA) developed and utilized by the VA that assesses organizational readiness for implementation of a specific, evidence-based clinical practice.
Session EPOP-154 12:30-1:30 p.m. Reducing Catheter Associated Urinary Tract Infections in the Adult Intensive Care Setting through Implementation of Catheter Rounds and Infection Alerts Kelsey Wick, MPH, Infection Preventionist, United Hospital, part of Allina Health; Jennifer Barry, BSN, RN, Patient Care Supervisor, Children’s Hospitals and Clinics of Minnesota; Christopher Allen, BSN, RN, CCRN, CNRN, Nurse Clinician, United Hospital, part of Allina Health; Mark Chlebeck, MSN, MBA, Patient Care Manager, University of Minnesota Physicians; Aimee Nelson, BSN, RN, CCRN, Patient Care Manager, United Hospital; Rebecca Siebenaler, BSN, RN, CCRN, Patient Care Manager, United Hosptial, part of Allina Health BACKGROUND: A higher incidence than expected of Catheter Associated Urinary Tract Infections (CAUTI) was occurring on a 14 bed Neuro Intensive Care Unit (ICU) and a 31 bed Medical/Surgical ICU within a 350 bed-hospital. There was no standard for ensuring best practices were applied for patients with an indwelling urinary catheter (IUC), nor were CAUTI details relayed to staff upon occurrence. To decrease CAUTI and increase awareness of prevention efforts, IUC rounds were initiated by an Infection Preventionist (IP) and nurse leaders on both units several times a week and CAUTI alerts were sent to nursing staff as an infection was identified. METHODS: Beginning in June 2014, an IP and ICU nursing leaders developed a plan to increase CAUTI awareness by implementing IUC rounds. IUC rounds included assessing the reasons for IUC along with visually assessing for elements of best practice. Rounding provided opportunity for feedback and education on maintenance practices, and necessity of IUC in real time. CAUTI alerts were shared with staff and included likely causes of infection following a thorough chart review and highlighted the best practices for preventing CAUTI.
RESULTS: Within one year of implementation of IUC rounds and CAUTI alerts there was a 57% decrease in CAUTI in the Med/Surg ICU, and a 33% decrease in CAUTI in the Neuro ICU. CAUTI and IUC rounding data was reported to staff monthly, providing an opportunity to highlight areas to focus improvement work. CONCLUSIONS: Through routine IUC rounds and real-time feedback as CAUTI occurred, the awareness of CAUTI increased amongst the health care team. In this setting, nurses have the opportunity to ask questions with IPs and nursing leaders, and often lapses in best practices are corrected early on aiding in infection prevention efforts. IPs participating with IUC rounds helped foster relationships with nurses and increased collaboration beyond CAUTI improvement initiatives.
Session EPOP-155 12:30-1:30 p.m. Reducing Central Line-associated Blood Stream Infections Through Expert Practice Franklin Benjamin, BSN, RNLatonya McCoy, RN, Infection Prevention, Florida Hospital; Tiffany Richens, MS, MPH, CIC, Infection Prevention-Project Manager/Educator, Florida Hospital; Vincent Hsu, MD, MPH, CIC, FSHEA, FACP, Hospital Epidemiologist, Florida Hospital; Suzanne Denza, BS, Quality Analyst, Infection Prevention, Florida Hospital BACKGROUND: Oncology patients are a distinct population requiring additional needs. Due to their immunocompromised status, central line associated blood stream infection (CLABSI) rates among Oncology patients are higher among the general inpatient population. In December 2015, an Oncology service line identified an increase in CLABSI rates specifically stemming from poor care and maintenance and realized a change in practice was necessary. METHODS: A standardized toolkit was developed based on the results of a root cause analysis and needs assessment of the staff through discussion and observation. The toolkit included a preassessment of the unit needs, an education plan, process implementation and revalidation of the process. The education was designed from the pre-assessment needs of the staff and focused specifically on care and maintenance of central lines, dressing changes, assessment of the dressing for risk of infection and checkoff on these skills. Upon completion of education, leadership implemented processes that audited central lines closely and began the two-person dressing change system described in the toolkit. Interdisciplinary rounds which included physicians, nurses, and infection prevention focused on line necessity and care were also implemented. Three months after initiation of the toolkit, the units began the revalidation process by leadership assessing the care and maintenance process of each staff member. RESULTS: The post intervention data was analyzed in March, 2016 after the completion of the education phase. There was a significant decrease in the CLABSI rates during that same time period (Pvalue = .044). This accounted for a 64% decrease in CLABSI rates. There was also a significant decrease in the device utilization rate (DUR) of central lines when comparing June 2015-February 2016 to March 2016-November 2016 (P-value <.001). CONCLUSIONS: A multidisciplinary development of a standardized toolkit that enhanced care and maintenance resulted in a significant decrease in CLABSI rates in the Oncology units.
APIC 44th Annual Educational Conference & International Meeting | Portland, OR | June 14-16, 2017