Download picc preventive bundle

Peripherally Inserted
Central Catheter
PREVENTIVE BUNDLE
Laurie Forssberg RN BSN
Diana Gadek RN BSN
Marlene Moreno RN BSN CRNI
Christine Mueller RN BSN
PROJECT AIM
• The purpose of this project is identifying the rate of
PICC (peripherally inserted central catheter) infections
and applying a preventive bundle that would decrease
the infection rate.
• Catheter related blood stream infections (CRBSI) are a
major concern of the PICC team at Loyola.
• Follow insertion guidelines and update our procedures
as new evidence based practice becomes available.
• Magnet Force 7: Quality Improvement
• Magnet Force 8: Consultation and Resources
Confidential: Quality Improvement Material
Background
• Preventing central line infections is one of the six key strategies
in the Institute for Healthcare Improvement’s (IHI’s) 5 Million
lives campaign.
• It has been noted that CRBSI’s account for the most serious and
costly of hospital acquired infections.
• This preventive bundle was created by utilizing the CDC’s
(Centers for Disease Control) Healthcare Infection Control
Practices Advisory Committee’s “Guidelines for Prevention of
Intravascular Catheter-Related Infections”. Additionally
SHEA/IDSA (Society for Healthcare Epidemiology of
America/Infectious Diseases Society of America) Practice
Recommendations “Strategies to Prevent Central LineAssociated Bloodstream Infections in Acute Care Hospitals” was
used.
Confidential: Quality Improvement Material
Solutions Implemented
• Ongoing education of team members regarding
the insertion of PICC’s to assure consistent
insertion guidelines are followed by all team
members.
• Practice change from a half sterile drape to a full
large sterile drape.
• Continued maximum sterile barrier use with
insertion: mask, cap, sterile gown and sterile
gloves are utilized.
Confidential: Quality Improvement Material
Solutions cont’d
• Continued pre-prep: Cleansing of the patient’s arm with
chlorhexidine soap and water.
• Continued use of 2% chlorhexidine-based antiseptic for skin
preparation.
• Introduction of the Invision Plus Intraluminal Protection System
Connector. A needle-free neutral injection cap with a straight
through fluid pathway with no dead space to trap air or blood
that may develop biofilm. In-service training was provided
system wide.
• Continued use of Stat Lock Catheter Securement Device is applied at
insertion and with every dressing change.
• Hand hygiene.
Confidential: Quality Improvement Material
PICC Infection Rate Results
PICC Infection rate
1.20%
Percent
1.00%
0.80%
0.60%
Infection rate
0.40%
0.20%
0.00%
2007
2008
Year
Note: The infection rate was determined by looking at the number of PICC infections
developed in hospitalized patients with lines inserted by the PICC Team.
Confidential: Quality Improvement Material
PICC Line Infection Results
Confidential: Quality Improvement Material
Analysis
• 2007: 1,573 PICCs inserted with 17 infections
documented.
• 2008: 1,687 PICCs inserted with 14 infections
documented.
• The rate decreased .26% from an infection rate
of 1.08% in 2007 to .82% in 2008. Goal of
having a less than 1% infection rate for 2008
was met. All steps in the process will be
continued.
Confidential: Quality Improvement Material
Next Steps
• Education of staff regarding guidelines to
prevent central line infections.
• Consider use of chlorhexidine baths or
chlorhexidine-containing sponge dressings for
patient’s with PICC lines.
• This project will be ongoing until a zero rate of
infection can be reached and maintained.
Confidential: Quality Improvement Material