West Palm BeachVAMedicalCenter
Central Line Infection Best Practices
Cindy Lang, RN, BSN, CIC – Senior Infection Control Specialist
In response to the 100K Lives Campaign the WPB VAMC addressed the CVC Compliance Items within the context of the Critical Care Committee. In addition to education it was realized that in order to comply with the Central Line Bundle Audit Items an organized approach was needed. Committee members agreed that staff members were more likely to adhere to the recommended practices for prevention of Catheter Related Blood Stream Infections (CR-BSI) if all of the supplies for catheter insertion were readily available in one place.
The facility contracted with MedLine (the distributors of the full barrier drape) to create Central Line kits which include the following supplies:
Central Line Tray (Arrow)
Cap (Hair cover)
Mask
Sterile gloves
Sterile gown
Full body drape
Chlorhexidine (ChloraPrep) Swabsticks
BioPatch Dressing
All of the supplies are packaged in one clear package with a Central Line Checklist.
Staff members (RNs and physicians) were educated on the 100K Campaign and the bundle items. Reinforcement was done daily in the ICU Interdisciplinary Rounds with:
Critical Care Physician (Intensivist / Pulmonologist)
ICU Clinical Pharmacist (Pharm D, BCPS)
Infection Control Practitioner (ICP)
Respiratory Therapist
Nurse Case Manager
Critical Care Clinical Nurse Specialist
Lead Unit Facilitator (ICU Charge Nurse)
Staff RNs
Clinical Dietician
Speech Pathologist
Students(Residents / Interns / Pharmacy Residents)
New Central Lines inserted the day prior are reviewed for compliance with bundle items. Nurses encourage physicians to comply with ALL bundle items and especially those items which some providers felt were optional (such as hair cover).
Feedback in terms of compliance with bundle items and CVC Infection Rates has been provided monthly since March 2006. MICU/CCU and SICU units received and compared their compliance and infection rates until October of 2006 when the individual units were merged into a “Mixed” ICU and a single report is supplied. The completed Central Line Checklists are given to the Infection Control Practitioner each morning during daily ICU rounds.
A worksheet was developed for reporting by the ICU staff to include a report of compliance with the Central Line Bundle Audit Items each day during rounds.
On Thursday, March 27, 2008 a proposal for a new Central Line Bundle Kit was presented to the Commodity Standardization Committee by Cindy Lang, ICP.
The kit contains a full body drape with 4 fenestrations at the right and left IJ/SC (internal jugular/subclavian) sites and the right and left femoral sites (which are discouraged from routine use and utilized only as a last resort.) Adhesive allows the drape to adhere to the skin at each site when the window is removed for access. The tray also includes the following items:
Central Line Bundle kit from Tri-State Hospital Supply Corp.
1 x foam tray – deleted due to GEMS program
1 x Sorbaview Ultimate dressing with adhesive-free zone
1 x Universal Tape Strip for added securement
1 x StatLock CV Plus securement device
1 x Biopatch
1 x large tinted Chloraprep, 10.5ml
1 x Chloraprep Applicator, 3.0ml
1 x premium skin prep pad
1 x Red “Infectious Waste” liner marked with Biohazard symbol, 30 x 36”
3 x Smartsite Luer-activated valves
1 x extra-large surgical gown
1 x large surgical gown
2 x large bouffants
2 x procedure masks with visors
1 x 60 x 90” drape with fenestration
1 x white wrap
This kit is packaged at 20 kits per case.
When needed the PICC securement device will be obtained separately for each PICC line insertion. It will not be included in the bundle.
Cindy Lang will provide a justification of line items to DiNora Bruno.
The Chief of PAD will research similar trays from the other VISN 8 facilities.
DiNora Bruno will advertise competition for the tray items.
A VISN contract will be sought to decrease the tray price.