White Oak Medical Center ICU: CLABSI-free in 2023
White Oak Medical Center achieves zero CLABSI in ICU by implementing evidence-based process improvement initiative for safety and quality.
The Challenge
According to the Centers for Disease Control and Prevention 1 in 31 patients will acquire a healthcare-associated infection while hospitalized. Some infections are associated with the use of life-saving medical devices such as central venous catheters, which can be a risk factor for the development of bloodstream infections. Adventist Healthcare White Oak Medical Center is committed to improving safety around medical devices and recognized an opportunity to reduce the infections associated with central lines.
Process Improvement
Using our standard lean management approach, an evidence-based process improvement (PI) initiative was implemented in June 2021 within the White Oak Medical Center Intensive Care Unit (ICU) to improve the management of central lines to ultimately reduce the incidence of Central Line Associated Bloodstream Infections (CLABSI) to zero.
To achieve this improvement, the interdisciplinary PI team focused on three (3) key initiatives, including: fostering better communication between nurses and physicians around device indications or the reason for device placement, adherence to evidence based CLABSI prevention bundles, and a workflow to facilitate device removal when no longer needed.
Communication
To help foster a culture of discussion around device indication, an ICU Bundle Compliance Tool was created to include a listing of approved indications for the use of the central line, a determination each shift around whether the indication was still valid for the patient, and to explore whether alternative venous access could be deployed. Each shift, the questions were answered on paper by the nurse and the selected indication was physically signed off by signature by the attending intensivist. Each month, a compliance rate was generated by calculating the percentage of signed worksheets submitted in each month.
Evidence-Based Bundle Compliance
Infection Prevention conducted observations at the bedside to observe for compliance with evidence-based bundle elements for CLABSI prevention, including the ability of the clinician to articulate the reason/ indication for the device, hand hygiene, daily chlorhexidine gluconate (CHG) bathing, dressing competence (use of CHG dressing, dressing clean dry and intact, dressing dated), and the placement of a label and date for any connected tubing or IV fluid bags.
Device Removal Process Mapping
A process map was collaboratively created for the ICU to ensure the proper management of a given patient’s central venous catheters to support timely transition to lower risk peripheral venous access, the removal of central venous access before discharge from the ICU through coordination with the vascular access nurse, an escalation process for the transition of tunneled dialysis central lines to permanent fistulas for eligible patients, and complete removal of vascular access where indicated.
Outcomes to Date
This fall, the ICU will celebrate nearly two (2) years without a central line associated bloodstream infection (CLABSI). Daily discussions between nurses and intensivists around central line indications are in the 90th percentile and central line infection prevention observations continue to range from the 90th percentile to 100 percent each month.
