Catheter Care Qi Project

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QI Project- Decreasing Infections in Central Lines
Jill Jasinski

UW Eau-Claire
BSN @ Home Program

Executive Summary
One of the most serious complications of central venous access is catheter-related bloodstream infection and is the leading cause of nosocomial infection. The focus of this QI project is to decrease the number of blood stream infections in patients with central lines. Benefits of this project include healthier patients and reduced costs to the patient and hospital. Prevention of catheter-related infection involves several measures which should be used in combination. The organization in which this QI project is implemented is an outpatient facility dedicated to providing chemotherapy blood and antibiotic infusions. Their mission is to provide patients with compassionates state of art care. These patients are usually being seen for antibiotic or blood administration in outpatient facilities. This organization also offers spiritual and mental health counseling to patients with cancer. The culture and climate for this proposed change is to improve the patient’s outcome for healing and continued care. The data collected for this project was found from guidelines used at other hospitals and evidence-based research reports and journals. Implementation strategies for decreasing central line-associated bloodstream infections goals focus on the importance of educating all staff and workers that are involved in managing and caring for central lines. Patient and family education is also important, especially for individuals with long term lines at home. The normative re-educative strategy is the change strategy that will be used for this process change. The major change agent for this initiative will be the Nurse Supervisor. The Nurse Supervisor will decrease resistance to change by encouraging group discussions and offering explanations of the intiative. The most important change to this initiative would be to include the use of a checklist to guide catheter insertion and maintenance; adequate training of the nursing staff involved in the management of vascular access and an adequate patient-to-nurse ratio. There will be a video and test available on the employee intranet for all nurses and Physicians involved in central line care. This training will be offered annually and is mandatory. After completing the video and written test a nurse will do central line care on a patient and he or she will be observed and evaluated by a certified team member. The Quality will maintain an infection control log/record in each department, to guarantee that infections are being identified timely and that these residents are being sufficiently monitored for infection. This log will be discussed in every monthly QAPI (Quality assessment and performance improvement) meeting. The director of QAPI program will monitor departmental quality assurance which will include each department of the hospital. The Chief Executive Officer and the director of nursing will conduct inspections to ensure follow through of the program. Important tasks in Central Line Care

Other tasks that are important to decreasing central line infection include the maximal use of sterile barrier precautions during catheter insertion. Research shows that incorporating chlorhexidine-based solution for skin antisepsis and use of the subclavian vein help reduce infection as well. Other things of equal importance are washing hands with antibacterial soap or an alcohol-based handrub solution before any manipulation of the infusion line. It is also recommended to remove any useless catheters because these may harbor infection. There has been controversy about the use of antimicrobial-coated CVCs. The census is that CVC’s should be reserved for ICUs where the incidence of catheter-related infection remains high despite adherence to guidelines. We will observe direct care staff while working with CL patients,   according to facility written protocols. The...