Central Line Associated Blood Stream Infections

and Chlorhexidine Gluconate Baths

A. Fisher SNJ. Canty SN

L. Pollock SN

To decrease the rate of central line associated blood stream infections

To increase knowledge on the purpose and effectiveness of chlorhexidine gluconate (CHG) baths in preventing CLABSI's

To understand the proper documentation of CHG baths in Cerner

Purpose

Central Line:An intravascular catheter that terminates

at or close to the heart in one of the great vessels

Used for infusions, withdrawal of blood,  or hemodynamic monitoring

CLABSI:A laboratory confirmed bloodstream

infection where the central line was in place >2 calendar days on the date of the even

Background

Broad spectrum anti-microbial properties

Works against MRSA and VRE Low toxicity Immediate and long-acting protection

Chlorhexidine Gluconate Wipes

NPSG.07.03.01Use proven guidelines to prevent infections

that are difficult to treat.

NPSG.07.04.01Use proven guidelines to prevent infection

of the blood from central lines.

National Patient Safety Goals 2014

Medications, catheter changes, lab tests, ICU transfers

Each CLABSI costs about $16, 550 per patient

As of 2008, hospitals are not reimbursed by CMS for CLABSIs that were not present on admission

CLABSI Costs

Between 12-15% of patients who acquire a CLABSI die

Roughly 250,000 cases per year 62,000 patients die

Extended hospital stays

CLABSI Complications

Bayfront CLABSI Rates: Rate of Infection: 1.11

Florida CLABSI Rates:Rate of Infection: 0.57

United States CLABSI Rates:Rate of Infection: 0.56

CLABSI Rates

Rizzo, E. (2014).

Plan-Do-Study-Act Improvement MethodCause & Effects Analysis- Fishbone

DiagramProcess Flow Charting

Improvement Tools & Methods

Cause & Effect Analysis

Process Flow ChartNurse receives

report that patient has a

PICC line

At an appropriate time, the nurse prepares to give

CHG bath

Chlorhexidine gluconate wipes gathered from supply room

Nurse begins CHG bath with wipes

Wipe only from the neck down, clean to dirty

Use new CHG wipe for each

area of the body

Document CHG Bath in

Cerner

Monitor for signs & symptoms of

possible infection

Remind the next nurse about CHG bath protocol at

shift-change

Nurse ManagerRegistered NursesPatient Care TechsPICC Nurses

Team Members

Track the number of line days for each patient with a central line

Documentation of chlorhexidine gluconate baths given to patients with a central line

Track and document the patients that develop central line associated blood stream infections

Measures

Results for CLASBI indicate a 53% rate reduction during CHG intervention (Karki 2012)

In one community hospital, CLASBI rates decreased from 3.8 to 1.6 per 1000 central line days, in 6 months of beginning the CHG bath intervention (Miller 2012)

VISIONCLASBI is largely preventable and a rate of

ZERO is an achievable goal (Miller 2012)

Process Improvement

Proper Techniques to Perform CHG Baths:

CHG wipes should not come into contact with eyes or ears

Only use CHG wipes below the jaw line Use a firm massage to remove bacteria Use a new cloth for each area of the body Let CHG air dry- do not wipe or rinse off Do not use soap and water on the skin after CHG

baths Dispose of CHG wipes in the trash DO NOT flush CHG baths should be given DAILY

Process Improvement

Process Improvement

IV Care

IV PICC Line Site

CHG Bath

Yes/No

Documentation in Cerner

Float nurses will need to be educated about the CHG bath protocol for patients with central lines

Limitations & Lessons Learned

Centers for Disease Control and Prevention, (2014). Central line associated blood stream infection event. Retrieved from website: http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf

Centers for Disease Control and Prevention. (2011). Vital signs: Central line-associated blood stream infections . Morbidity and Mortality Weekly Report, 60, 1-6. Retrieved from http://www.cdc.gov/mmwr/pdf/wk/mm60e0301.pdf

Centers for Medicare and Medicaid Services. (2008, October 01). Hospital-acquired conditions (present on admission indicator). Retrieved from http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html?redirect=/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp

References

Karki, S., & Cheng, A. (2012). Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. Journal Of Hospital Infection, 82(2), 71-84. doi:10.1016/j.jhin.2012.07.005

Miller, S., & Maragakis, L. (2012). Central line-associated bloodstream infection prevention. Current Opinion In Infectious Diseases, 25(4), 412-422.

The Joint Commission. (2014). Hospital national patient safety goals. Retrieved from http://www.jointcommission.org/assets/1/6/2014_HAP_NPSG_E.pdf

The Joint Commission. Preventing Central Line–Associated Bloodstream Infections: A Global Challenge, a GlobalPerspective. Oak Brook, IL: Joint Commission Resources, May 2012. http://www.PreventingCLABSIs.pdf.

The Leapfrog Group. (2013, October). Retrieved from Hospital safety score: http://www.hospitalsafetyscore.org/hospital/bayfront-medical-center-inc

Rizzo, E. (2014). Infection control & clinical quality. Beckershospital review. Shaffer, J. (2012). Bathing with chlorhexidine (chg) cloths . Infection Control and

Epidemiology, Retrieved from http://www.med.umich.edu/1libr/infectioncontrol/CHG.pdf

World Health Organization. (2014). Preventing blood stream infections from central line venous catheters . Retrieved from http://www.who.int/patientsafety/implementation/bsi/en/

References