Central Catheter Infections: Use of a Multidisciplinary Team to Find Simple Solutions

Abstract

“In Our Unit” highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an upcoming “In Our Unit, ” send it to CRITICAL CARE NURSE, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail, ccn@aacn.org. The team effort improved patient care, the hospital’s bottom line, and our own professional satisfaction. Inspired by the Institute for Healthcare Improvement’s “100,000 Lives Campaign,” Hunterdon Medical Center organized an interdisciplinary team to tackle central catheter bacteremias. The team, led by the intensive care unit (ICU) clinical coordinator, also consisted of a nurse epidemiologist, the quality improvement director, the process improvement manager, the ICU nurse manager, and the medical director. We chose the Six Sigma improvement methodology to help us define, measure, analyze, improve, and control our process. According to a review of the data, our unit had incurred 3.3 central catheter infections per 1000 catheter days during 2005, which translated to 6 central catheter infections for the year at an approximate cost of $40 000 per infection or $240 000 for the year. It was clear that we had some work to do, not only for the financial implications but, most importantly, to prevent these life-threatening infections in our patients. We began by examining the entire central catheter process, from insertion to removal, and identifying opportunities during the process that could lead to infection. The team determined that the following factors potentially increased a patient’s risk of infection through the central catheter: • choice of insertion site, • skin preparation material and technique, • use of sterile barriers during insertion, • dressing maintenance and change techniques, and • use of aseptic technique during catheter access. The team identified baseline measurements of compliance with recommended practices in each identified area. ICU nurses observed physicians’ use of infection control practices during catheter insertions, completing central catheter insertion checklists with each insertion. This checklist included documentation of insertion site; hand washing or alcohol cleansing before insertion; and use of maximum barriers precautions. Our nurse epidemiologist produced graphs from the resulting data, which were shared with the physicians involved. In addition, a data collection sheet was created for baseline