Critical Care units reach zero rate of central-line infections
Three critical care units in the Saskatoon Health Region are using the Safer Healthcare Now! bundles for central-line care and their results have been impressive. The unit at Royal University Hospital (RUH) has not had a central-line associated blood stream infection (CLA-BSI) since June 2010; and the two units at St. Paul’s Hospital (SPH) have not recorded a CLA-BSI since April 2011. Their success can be attributed to a combination of standardization, education, communication and measurement.
Physicians and nurses working on the critical care units move back and forth between the two hospitals, therefore, standardization of practices was key to ensure that insertions are done the same way with every patient. Central-line carts have been set-up with all of the proper equipment in place; and a checklist has been developed to outline the process the department follows for central-line insertion. The checklist has since evolved and is integrated into the daily practice as a progress note where the physician documents the central-line insertion, and it is placed on the patient’s chart.
“Reducing variation and standardizing practices really helps to drive your work forward,” says Patti Simonar, Director of Critical Care and Emergency Services for the Saskatoon Health Region. “We try to operate the same way – it is not the RUH way or the SPH way; it is the critical care way of doing things.”
The Safer Healthcare Now! framework helped the team to identify the barriers to achieving lower rates of infection. Carts were then implemented to make it much easier for physicians to insert a central line; everything they need is in one place and they are the same on every unit. The checklist was developed to ensure that all steps are followed; and the data collected to measure compliance tells them how well they are doing.
“Using the checklist was a different approach and when we presented the rationale and the evidence, the team members could see the benefit,” says Betty Wolfe, ICU Manager, St. Paul’s Hospital. “We measured compliance with the insertion bundle using the checklist and we had the nurses self-audit their compliance with the care bundle. It served as a reminder of the steps to be followed.”
“A big part of the checklist is giving permission and empowering nurses who work closely with the physicians doing the central-line insertions,” says Dr. Susan Shaw, former Department Head of Adult Critical Care. “You need a culture where they are comfortable saying, would you please stop ... you haven’t scrubbed properly, you are not wearing a mask, or we think you have contaminated your set-up. We want all members of the team to feel safe and empowered to stop the line insertion and do what is right for the patient,”
“We have a long history of being involved in the Canadian ICU Collaborative and we all have the same problems that we need to fix,” says Dr. Shaw. “Safer Healthcare Now! provides the evidence, best practices, tools and a framework to follow. Implementing the carts and the checklist made it easy to do the right thing and really hard to do the wrong thing.”
CLA-BSI education is layered and delivered to the provider in a number of ways, including a storyboard at each site, newsletters, regular huddles with staff, daily rounds with multi-disciplinary teams and regularly scheduled education days. While CLA-BSI rates are no longer monitored as closely, if the Saskatoon Health Region has even one infection, they say it will be treated as a harmful incident, and a cause analysis and harmful incident reporting would be done.
The Safer Healthcare Now! Preventing Central-Line Infections Getting Started Kit can help you to achieve zero rates of infection. Visit www.saferhealthcarenow.ca/interventions to download a copy of the Getting Started Kit.