Objective: Utilizing creativity and determination to decrease bacteremia rates in our Surgical Intensive Care Unit, a multidisciplinary Performance Improvement Committee identified ways to improve practice related to central line insertion, care and maintenance. Design: Full barrier precautions (sterile gowns, gloves, mask for physicians and nurses; sterile body drape for the patient) were implemented during central line insertion and rewire. Several types of dressings were evaluated in an effort to identify a product that would remain occlusive. Population, Sample, Setting, Years: All patients in the Surgical Intensive Care Unit with any type of central line. This has been going on for 3 years and continues. Intervention and Outcome Variables: Monitoring of bacteremia rates daily (positive cultures/central line days). Monitoring quarterly the occlusiveness of all central line dressings. Methods: The SICU “Line Cart” was developed to contain all supplies needed to facilitate full barrier precautions and compliance with infection control practices. Physicians were required to complete a PowerPoint education program for central line insertion. The staff was educated regarding the full barrier precautions, use of the line cart and accurate application and maintenance of the newly selected central line dressing. Findings: After three years, the SICU at the Johns Hopkins Hospital has shown significant decrease in central line associated bacteremia rates to the lower end of the NNIS Incidence rates. Conclusions: Other intensive care units at the Johns Hopkins Hospital have adopted these guidelines/practices for insertion and maintenance of central lines. The goal is to develop a culture of perfection in practice and that any breach in infection control practice is to be corrected immediately. Implications: Our latest effort includes the use of a care team checklist to ensure compliance with all infection control practices related to central line insertion. We found that strict adherence to practice can keep the bugs out.
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Back to 14th International Nursing Research Congress
Sigma Theta Tau International
10-12 July 2003