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Prevention of Central Line Infections

What is a Central Line-Associated Bloodstream Infection (CLABSI)?  A “central line” is an intravenous catheter that is placed into a large vein in a patient’s neck, chest, arm, or groin and ends near the heart or in a large central vein.  It is different than a regular IV catheter.  It is used to draw blood, give fluids or medications, and it may be left in place for a long period of time, even for outpatient therapy.  Having a central line places a patient at risk for developing an infection unless best practices are performed to prevent it.  A bloodstream infection can occur when bacteria or other germs enter the blood as part of using this catheter to provide care, by maintaining the catheter, or through the area where it is inserted into the body. A central line-associated bloodstream infection is serious, but often can be successfully treated.

 

All three BH hospitals worked together to develop an online invasive line procedure note which promotes and documents the use of evidence-based interventions, as well as the pre-procedure time out.

 

Prevention of central line-associated bloodstream infections include the following best practice bundle measures:  

  • hand washing before and after inserting the catheter
  • selecting the best body location for insertion
  • using maximum sterile barrier drapes and attire during the insertion
  • using chlorhexidine gluconate and alcohol skin preparation for all patients over 2 months of age
  • using antimicrobial impregnated catheter and Chlorhexidine gluconate impregnated dressing
  • inserting the lowest number of lumens needed for care
  • aseptic management of the lines, tubings and fluids
  • changing the catheter only when needed and removing it when it is no longer necessary

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  • A mandatory online education program and mentoring by expert clinical staff have been incorporated into learning. 
  • Best practices for insertion of central lines are taught and validated in the Simulation/Skills Center. 
  • Dedicated advanced practice nurses insert lines in the NICU, Interventional Radiology and on the IV team.
  • Baystate Medical Center participates in the Massachusetts Hospital Association Getting to Zero Campaign to eliminate CLABSI.  
  • Our multidisciplinary task group is working on 5 areas of improvement & standardization: education, criteria for insertion, bedside staff engagement, supply standardization, and documentation. 
  • Each CLABSI that occurs is reviewed in a "Root Cause Analysis," identifying areas for improvement or gaps in current practice for ongoing learning and improvement of patient care.
  • Standardization of line carts, line site care kits, equipment, products, policies, and procedures for insertion and post-insertion care have helped to significantly decrease rates of central line-associated bloodstream infections hospital-wide. 
  • Compliance with the evidence-based blood stream infection bundle is consistently high. 
  • The ICU and CVICU have joined the nationally recognized Comprehensive Unit-Based Safety Program (CUSP) to enhance patient safety in the intensive care setting. 
  • The NICU has joined the national NCABSI ( NICU CUSP) program, actively participating and sharing best practices.  
  • Focus housewide is on reducing CLABSI and reporting patient outcomes on a monthly basis.
  • The CLABSI rate in many inpatient units is currently 0%.  

   

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  • Compliance with the insertion bundle has been at 100% for the past 2 years.
  • Data related to central line-associated bloodstream infections are monitored by the Infection Control Committee and by the Medical-Surgical and Critical Care Service Line Teams.

 

For more information on Quality at Baystate Health

For more information on Baystate Medical Center

For more information on Baystate Franklin Medical Center

For more information on Baystate Mary Lane Hospital

For more information on Baystate Home Infusion and Respiratory Services

 

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  • “Central Line Kits” have been assembled and contain all necessary personal protective equipment to ensure compliance with insertion guidelines.  A Central Line Bundle Check List is included in the cart and prompts staff to complete the CIS online documentation.
  • All “central line bundle measures” are tracked and reported semi-annually.  Compliance with the evidence-based blood stream infection bundle is consistently high.
  • There have been no central line-associated bloodstream infections in the past 6 years.

 

For more information on Quality at Baystate Health

For more information on Baystate Medical Center

For more information on Baystate Franklin Medical Center

For more information on Baystate Mary Lane Hospital

For more information on Baystate Home Infusion and Respiratory Services

 

 

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  • BHI&RS has implemented all of the BH recommended central line-associated bloodstream infection prevention interventions, including bio-patch and chlorhexidine gluconate dressings.
  • In 2012, the central line-related bloodstream infection rate was slightly higher than the Strategic Homecare Programs national benchmark.
  • The current 2013 central line-related bloodstream infection rate is zero.

 

For more information on Quality at Baystate Health

For more information on Baystate Medical Center

For more information on Baystate Franklin Medical Center

For more information on Baystate Mary Lane Hospital

For more information on Baystate Home Infusion and Respiratory Services