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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