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Saturday, 29 October 2011
Learning Objective 1: Verbalize potential sources of infection of central lines in adult patients such as site selection, dressing and hub care, hand hygiene compliance, and engineering factors.
Learning Objective 2: Verbalize the use of six sigma process improvement methodology to successfully, systematically redesign complex systems and processes to achieve measurable outcomes.
Central line-associated bloodstream infections (CLABSI) are a persistent problem in U.S. ICUs, resulting in increased costs, length of stay, and mortality. Research aimed at infection reduction through improved insertion methods has been published; however, little information or research regarding the effect of daily maintenance on infection rates is available. Insertion provides opportunity for contamination, but daily access, maintenance, and environmental practices by staff provide multiple opportunities for contamination each day. The purpose of this study was to determine the best practices to eliminate CLABSI in adult intensive care units (ICUs), as well as barriers to these practices. The final aim of the study was to develop, test, and adopt a comprehensive strategy to eliminate these infections in two ICUs at a community hospital. Based on initial Six Sigma flow mapping of processes, findings in research, and a staff questionnaire, a data collection plan was developed. Three months of observations were collected to pinpoint variations in practice and deviations from best practice. Based on this data, changes were made to policies and documentation. An education module focusing on maintenance was presented to all nurses in the ICUs. Audit and feedback were continued over time and additional problematic data were addressed as needed. CLABSI rates dropped dramatically and remained well-controlled as the process improvement project continued. A multiple method, continuous approach to sustained behavioral change was essential to success. A major advantage of this approach is that it could be tailored for any institution, unit, or problem. The use of staff members to collect data, drive change, and disseminate education likely contributed to both acceptance and sustainability of changes.
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