Education, Research, and Quality Improvement: Education, Research, and Quality Improvement II |

RN/RT Partnership to Prevent Central Line Blood Stream Infections (CLABSI) FREE TO VIEW

Laura Miske, MSN; Michele Vizy, MEd; Beth Ely, PhD
Author and Funding Information

Childrens Hospital of Philadelphia, Philadelphia, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):620A. doi:10.1016/j.chest.2016.08.712
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SESSION TITLE: Education, Research, and Quality Improvement II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: To decrease the incidence of Central Line Blood Stream Infections (CLABSI) in pediatric patients with pulmonary comorbidities.

METHODS: Our 24 bed pulmonary unit experienced 5 CLABSI's in 14 months with 4 of the 5 occurring in patients with tracheostomy tubes; 3 occurred between 8/1/14 to 1/31/15 (Line Days = 1133). Using quality improvement methodology, a multi-disciplinary team formed in April 2015 to create tests of change to prevent CLABSI; >Education to limit access of central venous lines (CVL) during respiratory aerosol or airway clearance treatments in order to limit possible contribution to CVL bacterial contamination. > Weekly rounds with vascular access RN to compare documentation of dressing with visual observation. >Initiated CVL dressing changes with a 2nd person as a “coach” to maintain sterile procedure. >Developed a tip sheet of “Do’s and Don’ts” for RN's and RT's related to CVL. >A special magnet was placed on the door frame of the patient’s room to identify patients with a CVL.

Success Measures: Data analyzed to determine respiratory medication treatment times in relation to CVL access, such that the central line would not be accessed within 30 minutes of when the patient received a treatment meant to induce cough. Harm prevention work focused on audits to measure daily CHG bathing compliance (goal 90%) and dressing changes performed per procedure 100% of the time. Final goal of zero CLABSI events.

RESULTS: From 7/1/15 to 2/29/16 (Line Days = 1722), 2 patients were diagnosed with a CLABSI. Neither patient had a tracheostomy. Data analysis done 5 months apart, of administration of CVL and inhaled medications within 30 minutes of each other, reveals 78 less occurrences despite 107 more line days during the second analysis. CHG bathing compliance increased from 82% to 96%. All 55 RN’s completed new CLABSI prevention education with post-test.

CONCLUSIONS: Multidisciplinary education with targeted interventions can improve harm prevention bundle compliance and decrease CLABSIs.

CLINICAL IMPLICATIONS: CLABSI are a major source of morbidity and mortality. In patients with chronic pulmonary conditions, extended use of IV antibiotics may be needed, so CVL is preferred. We recommend identification of patients with CVL's in order to limit IV access during cough-inducing treatments, as well as enforcement of care guidelines for patients with CVLs as methods to prevent CLABSI.

DISCLOSURE: The following authors have nothing to disclose: Laura Miske, Michele Vizy, Beth Ely

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