Recruiting nurses in the fight against CLABSI
Hospital implemented dedicated IC nurses, eliminated infections
After reading this article, you will be able to:
- Explain how a dedicated IC nurse can help eliminate CLABSI infections
- List the important best practices for CLABSI prevention
- Analyze the importance of culture change in infection prevention programs
Even with all the effort IPs put into data collection, surveillance, and education on a daily basis to prevent central line-associated bloodstream infections (CLABSI), sometimes all it takes is the dedication of a few nurses to get the desired results.
A study presented at APIC's 2011 annual conference, held June 27-29 in Baltimore, showed that by appointing IC nurses to specifically oversee central line insertion and maintenance procedures, a hospital could eliminate CLABSIs in a matter of months.
Researchers from the University of Maryland Medical Center (UMMC) showed that dedicated nurses on the facility's surgical ICU (SICU) sustained a rate of zero CLABSIs for a 25-week period, eliminating an estimated 14 infections and saving two to three lives. The reduction also saved the hospital more than $200,000 over the six-month period.
"This is truly an example of taking infection prevention directly to the patient's bedside," Russell N. Olmsted, MPH, CIC, APIC's 2011 president, said in a press release.
Although the infection prevention department helped educate nurses on evidence-based best practices and collected data on subsequent infections, the nursing department was the primary driver, says Michael Anne Preas, RN, BSN, CIC, an IP at UMMC and lead author of the study.
"The director of nursing for the med-surg division said, 'I don't care how you get this done. If you need to assign someone specifically to monitor these activities, then let's do that,' " Preas says. "So that was what they did, and they made reducing infections a big deal."
Training and educating nurses
Before implementing devoted IC nurses on the SICU, the nursing department held a multidisciplinary educational summit that revolved around IC. During the half-day in-house conference, nurses from the SICU and ICU-with help from the IC department-presented on various infection prevention measures such as hand hygiene, best practices to prevent ventilator-associated pneumonia and catheter-associated urinary tract infections, and the well-known prevention measures for insertion and maintenance of central lines. It was then that the nursing staff realized the impact that could be made simply by ensuring that each step on the CLABSI checklist was followed during each procedure.
Appointing dedicated IC nurses
The nursing department quickly decided to move forward with appointing specific IC nurses for the sole purpose of monitoring infection prevention best practices, particularly those involving CLABSI prevention.
"They said, 'You have to want to be the one that does it, so you have to apply for this position as the infection control nurse. You're not just going to be assigned this job description; you have to want it and we're going to train you,' " Preas says. "And the training really revolved around what to look for."
IC nurses were appointed to the role on a two-week assignment for 40 hours each week. During the assignment, those nurses were completely removed from patient care so they could focus all their attention on monitoring central line insertions. They also staggered their hours so they were there when the night shift came in, which allowed them to cover educational components such as maintenance of central lines.
"They also monitored central line dressing checks on a daily basis to make sure they were dry and intact and to ensure their integrity was maintained," Preas says. "Plus, they monitored hand hygiene practices. They would call all staff out for breaches in hand hygiene, any noncompliance with isolation, and they provided reminders such as, 'Don't forget to scrub the hub when accessing the central venous catheter port.' "
IC nurses also conducted a daily five-minute huddle with the rest of the nursing staff to talk about the elements of infection prevention and provide reminders about hand hygiene. In addition to policing central line compliance, the IC nurses were also responsible for providing feedback on general IC best practices and overseeing environmental management to ensure that each room was clean and free of clutter.
The nursing department at UMMC was able to juggle staffing patterns in order to free up full-time IC nurses without having to hire additional employees, although the department was willing to bolster its staffing if necessary. "The commitment was there that if there was a need for another nurse, then they were going to staff that position to ensure a nurse was free and available to be a dedicated infection control nurse," Preas says.
Developing a culture change
By allowing the nursing department to take ownership of IC, a natural culture change began to permeate the department, Preas says. During each two-week rotation, more nurses began recognizing the impact of preventing central line infections. The pilot program was originally slated for three months, but was extended after CLABSI rates quickly dropped to zero and remained there.
The dichotomy between nurses and doctors is traditionally precarious. Doctors or other staff members may not always respond positively when a nurse calls them out for not properly washing their hands or not tying their gowns around their necks during central line insertion. But Preas says UMMC preempted this attitude with an educational summit specifically for surgical care intensivists and surgeons where physician leaders explained the importance of CLABSI prevention and the role of the IC nurse during this new program.
Keeping staff members motivated to maintain a zero infection rate was crucial to the success of the program. The SICU nurses received constant feedback from the IC department. Infection rates were posted on a large whiteboard each week and sent electronically to unit stakeholders. It quickly became an ongoing contest to make sure the streak wasn't broken, Preas says.