Central Line Associated Blood Stream Infections and Chlorhexidine

Central Line Associated Blood Stream Infections and Chlorhexidine Gluconate Baths A. Fisher SN J. Canty SN L. Pollock SN

Purpose u. To decrease the rate of central line associated blood stream infections u. To increase knowledge on the purpose and effectiveness of chlorhexidine gluconate (CHG) baths in preventing CLABSI's u. To understand the proper documentation of CHG baths in Cerner

Background u. Central Line: u An intravascular catheter that terminates at or close to the heart in one of the great vessels u Used for infusions, withdrawal of blood, or hemodynamic monitoring u. CLABSI: u A laboratory confirmed bloodstream infection where the central line was in place >2 calendar days on the date of the even

Chlorhexidine Gluconate Wipes u. Broad spectrum anti-microbial properties u. Works against MRSA and VRE u. Low toxicity u. Immediate and long-acting protection

National Patient Safety Goals 2014 u. NPSG. 07. 03. 01 u Use proven guidelines to prevent infections that are difficult to treat. u. NPSG. 07. 04. 01 u Use proven guidelines to prevent infection of the blood from central lines.

CLABSI Costs u. Medications, catheter changes, lab tests, ICU transfers u. Each CLABSI costs about $16, 550 per patient u. As of 2008, hospitals are not reimbursed by CMS for CLABSIs that were not present on admission

CLABSI Complications u. Between 12 -15% of patients who acquire a CLABSI die u. Roughly 250, 000 cases per year 62, 000 patients die u. Extended hospital stays

CLABSI Rates u. Bayfront CLABSI Rates: u Rate of Infection: 1. 11 u. Florida CLABSI Rates: u Rate of Infection: 0. 57 u. United States CLABSI Rates: u Rate of Infection: 0. 56 Rizzo, E. (2014).

Improvement Tools & Methods u. Plan-Do-Study-Act Improvement Method u. Cause & Effects Analysis- Fishbone Diagram u. Process Flow Charting

Cause & Effect Analysis

Process Flow Chart Nurse 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 Use new CHG wipe for each area of the body Wipe only from the neck down, clean to dirty Nurse begins CHG bath wipes Document CHG Bath in Cerner Monitor for signs & symptoms of possible infection Remind the next nurse about CHG bath protocol at shift-change

Team Members u. Nurse Manager u. Registered Nurses u. Patient Care Techs u. PICC Nurses

Measures u. Track the number of line days for each patient with a central line u. Documentation of chlorhexidine gluconate baths given to patients with a central line u. Track and document the patients that develop central line associated blood stream infections

Process Improvement u. Results for CLASBI indicate a 53% rate reduction during CHG intervention (Karki 2012) u. 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) u. VISION u CLASBI is largely preventable and a rate of ZERO is an achievable goal (Miller 2012)

Process Improvement u. Proper Techniques to Perform CHG Baths: u CHG wipes should not come into contact with eyes or ears u Only use CHG wipes below the jaw line u Use a firm massage to remove bacteria u Use a new cloth for each area of the body u Let CHG air dry- do not wipe or rinse off u Do not use soap and water on the skin after CHG baths u Dispose of CHG wipes in the trash DO NOT flush u CHG baths should be given DAILY

Process Improvement

Documentation in Cerner IV Care IV PICC Line Site CHG Bath Yes/No

Limitations & Lessons Learned u. Float nurses will need to be educated about the CHG bath protocol for patients with central lines

References u Centers for Disease Control and Prevention, (2014). Central line associated blood stream infection event. Retrieved from website: http: //www. cdc. gov/nhsn/PDFs/psc. Manual/4 PSC_CLABS current. pdf u 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/mm 60 e 0301. pdf u Centers for Medicare and Medicaid Services. (2008, October 01). Hospital-acquired conditions (present on admission indicator). Retrieved from http: //www. cms. gov/Medicare-Fee-for-Service. Payment/Hospital. Acq. Cond/index. html? redirect=/Hospital Acq. Cond/06_Hospital-Acquired_Conditions. asp

References u u u u 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 Global. Perspective. Oak Brook, IL: Joint Commission Resources, May 2012. http: //www. Preventing. CLABSIs. 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/1 libr/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/