Getting Physicians To Comply: Improving Adherence to Full Barriers during Central-Line Insertions

Abstract

BACKGROUND/OBJECTIVES: A 467-staffed bed tertiary hospital was the setting for this study. Barrier precautions audits for central-line insertion showed inconsistent practices for full body sterile drapes. Different sized drapes were used; only 17% used a “full-body” drape. Sterile gown usage was just 71%. The audit revealed a need to improve the existing process. An organizational learning approach to achieve sustained change was employed. Objective was to achieve 100% adherence with full barrier practices. METHODS: Organizational and personal learning were the focus, including: • Infection Control Department research for the optimal “large” drape size. • Using a staff focus involving, - Intensive care unit (ICU) intensivists for input on drape size. - ICU nursing staff for process auditing. • Using environmental cues to reinforce learning and provide standardization. - A visual poster defining “full body” drapes - Redesigned central line kits for consistency and inclusion of the large drape. - Adding an extra large sterile gown on the central line insertion cart. • Education - On maximal sterile barriers for Residents/physicians - Personal learning through an education newsletter for nursing staff. RESULTS: A follow-up audit after the learning process in the intensive care units showed consistent sterile gown and full body sterile drape usage. Results Pre-intervention 2004 (n = 24) Post-intervention 2005 (n = 28) Barriers worn Barriers worn Cap worn (100%) Cap worn (100%) Mask worn (100%) Mask worn (100%) Sterile gown (71%) Sterile gown (100%) Sterile gloves (100%) Sterile gloves (100%) Full body sterile drape (17%) Full body sterile drape (92%) CONCLUSIONS: Health care criteria for performance excellence goals includes using coordinated approaches that result in learning to improve quality. The ICU nurses and intensivists motivated staff to use their full potential toward a homogenous goal. Environmental factors, (e.g., redesigned kit), contributed to sustained practice by limiting choices to the “full body” drape. The poster was a reminder of correct practices in the ICUs. Full barrier education to staff physicians helped achieve credible models for Residents/interns. This multi-faceted approach contibuted to consistent barrier use.