Impact of the Standardized Management CVCHospital del Trabajador de Santiago

Santiago, ChilleRN M l Q i t illRN Marcela Quintanilla

January 1st to December 31st, 2010

The Issue

• The Hospital del Trabajador de Santiago is a Hospital i li d i tspecialized in trauma

• The rate of IBSRC and Insertion Site increased in I t i C U it b t 2008 2009 Intensive Care Unit between 2008 – 2009 years

• With a surveillance system we found a great variability of procedures techniques for CVC maintenanceof procedures techniques for CVC maintenance

The Intervention

Involve: Meeting of physicians and nurses for analyzing the issue and to taking actionsand to taking actions.Education: Train physicians (anesthetist, intensive care physicians) and nurses on:

– Add transparent dressing with Chlorhexidine gel pad (Tegaderm CHG) for covering CVC I.V. Sites (Non-Tunnelized) in patient in ICU. Except patients with history of allergy, burned patients, diaphoretics and the ones that have less than 24 hrs of installation.

– Change the transparent Dressings every 5 days, preparing the skin with Chlorhexidine

– Train in application and removal techniques for the transparent dressings

– Surveillance bi-monthlySurveillance bi monthly– Maintain monitoring

The Results

• We compare the rate of IBTRC between 2009 and 2010Th CVC IV Sit i f ti d d f • The CVC IV. Site infection decreased from 3,8 to 2,7 x 1000 days

• Cost related to 1 bacteremia according to American • Cost related to 1 bacteremia, according to American publications is between USD 3,700 to USD 29,000

• Cost during 2009 = USD 145.0000. gPost-intervention cost decreased in 2,5 times.

• Total Cost of the intervention in H it l d l T b j d USD 11 300 Hospital del Trabajador = USD 11,300 (Training + Tegaderm CHG)

Engaging Othersg g g

• Engaging the ICU team with Medical Director and ith th I f ti P ti C itt twith the Infection Prevention Committee support

• In stage 1, Clinical nurses didn’t accept the new t h l (T d CHG) b th did ’t t t it technology (Tegaderm CHG) because they didn’t trust it. Gradually nurses begun to trust in the new product and gradually results improvedgradually results improved.

• Nurses gained experience, so they could decide when to change the Transparent dressing according to the change the Transparent dressing according to the saturation of the Chlorhexidine gel pad.

Greatest Learnings / Largest Challengesg g g

• Interventional plans based on effective actions are useful only with active and systematic surveillanceonly with active and systematic surveillance

• Have to consider in the intervention program the Demming’s quality CircleDemming s quality Circle

• Results must be measured considering the learning process of the people involved.

• Infection Prevention Committees must lead this kind of issues and receive Medical Director support

Your Best AdviceStandardizing the practices of non- tunneling CVC i t d ti ith CVC maintenance and continue with active surveillance.

Sustaining Changeg g

Continue with epidemiologic surveillance bi-monthly, i t t ith di t f db k f th measuring quarter rates with direct feedback of the

clinical team.