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Acute Myocardial Infarction	Medication Reconciliation (ADE)
Boards on Board	Pressure Ulcers
Catheter-Associated UTI	Rapid Response Teams
Central Line Infections	Surgical Complications
Congestive Heart Failure	Surgical Safety Checklist
High-Alert Medications	Surgical Site Infections
MRSA	Ventilator-Associated Pneumonia

Use this table to quickly find a mentor for the prevention of Central Line Infections with demographics similar to your own, or use 'ctrl+f' in your web browser to search for specific key words on this page.

Arkansas Children's Hospital – Little Rock, AR
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 316
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: March 2005
Mentor Contact Name: Craig H Gilliam,  BSMT, CIC - PICU and Michele Honeycutt, RN, CIC - NICU
Mentor Contact Email: gilliamch@archildrens.org or honeycuttmd@archildrens.org
Mentor Contact Phone: 501-364-1322 or 501-364-3722

Additional Information:

2009 Data

In the PICU, the baseline rate was 3.0/1000 CVC days in 2005, the annual rate in 2007 was 1.6/1000, and the 2009 rate was 1.4/1000 CVC days.  Each of the ICUs achieved greater than 95-day intervals between catheter bloodstream infections.  The NICU had zero infections from CVC; the rate for umbilical lines was 0.6.1000 UVC days and 0.7/1000 PICC days.  The NICU celebrated 24 months without a broviac bloodstream infection in December 2009.

In the hospital when comparing the number of catheter bloodstream episodes by type of catheter:
 
Year           2006     2007     2009      % reduction
Broviac       23        9          4                 83
PICC          44        36        17                61

PICU had instituted maximum barrier precautions prior to insertion of CVC, antibiotic impregnated catheters, hand hygiene with antimicrobial soap, use of chlorhexidine for skin antisepsis, and transparent dressings.  A team to guide the interventions in our PICU included the PICU Intensivist - Team Co-Leader, staff RN Co-Leader and Nursing Director.  In addition, the Director of Infection Control provided data support.  Since 2005, we have added chlorohexidine impregnated (Biopatch ®) and chlorohexidine scrub the hub campaigns.  
 
Exceeded goals for compliance with the bundle for insertion and weekly dressing changes. Our baseline for insertion was 30%.  In 2009 ,PICU is >95% compliant on insertion bundle.  The CVICU reports 100% compliance with insertion and maintenance bundles.  The PICU and CVICU participates in national collaboratives to decrease rates.

By participation in collaboratives, we estimate avoiding 18 catheter bloodstream infections and greater than $600,000 in cost savings from both units since October 2006.

Our goals for 2010 include:

• Continue the spread of IHI bundles with modifications  Hematology/Oncology and short gut syndrome populations. 
• Increase the intervals between catheter bloodstream infection from 120 days in PICU, CVICU and NICU.

Mentor designation - 3/06
Information updated - 2/16/10

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Beth Israel Medical Center – New York, NY
Availability Status: Available to answer requests
Licensed Beds: 1374
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: June 2005
Mentor Contact Name: Brian Koll, MD
Mentor Contact Email: bkoll@chpnet.org
Mentor Contact Phone: 212-420-2853

Additional Information:

Implementation of a set of interventions known as the “Central Line Bundle” in all patients requiring a central line using Plan-Do-Study Act (PDSA) methodology.
PDSA methodology first introduced in one ICU, then all ICUs, then the Emergency Department, then all other patient care areas.

Each patient care unit assumes responsibility for initiative with oversight by Department of Infection Control.

Physician and Nurse re-education and recertification on central line insertion technique and maintenance practices was done.

Standardization of practices to ensure that: maximal barrier protection utilized; appropriate skin prep with chlorhexidine; and preference for subclavian site unless medically contraindicated.

Nursing empowerment to monitor practices included: Nursing permitted to ask and stop other persons who do not follow appropriate practices.

Hand hygiene compliance monitored.

Daily review of line necessity is conducted.

Root cause analysis performed in real time for every CLAB.

Development of a central line insertion kit to enable maximal utilization of: barrier precaution components, insertion components and line maintenance components.

CLABs were eliminated with limited additional resources.

Use and monitoring of evidence based patient care practices or “bundles” with reporting back of data to end users resulted in the rapid and sustained elimination or decreased incidence of CLABs on many units.

Efforts were effective for all areas of the hospital where central lines are inserted.

Significant reduction in CLABs
• 61% reduction for institution
• Within 90 days, achievement of zero CLABs in a variety of units.  Many units without a CLAB for 6+ months.
• Reduction in morbidity and mortality
Daily review of need for line necessity
• 20% decrease in central line days
Reduction in costs incurred in caring for patients with CLABs
• $805,000 costs avoided
• 53% reduction in costs from 2004
Costs to implement
• Additional $15 per line inserted
• Total additional costs $30,000

[3/30/06]

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BryanLGH Medical Center – Lincoln, NE
Availability Status: Available to answer requests
Licensed Beds: 378
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: January 2004
Mentor Contact Name: Larry Krebsbach
Mentor Contact Email: lkrebsbach@bryanlgh.org
Mentor Contact Phone: 402-481-8945

Additional Information:

In 2004 we began using chlorhexidine antiseptic for central line insertions and dressing changes.  We also started using a larger drape for insertions and during 2004 and 2005 stressed the need for full sterile barrier technique during insertions.  During daily rounds in the ICU we ask about the need for central lines.  In 2006 we began the use of a sterile procedure cart in the ICU's.

We have gone from an overall rate in our three ICU's of 1.86 bloodstream infections per 1000 central line days to 0.26 bloodstream infections per 1000 central line days.  One of our ICU's had gone 682 days without a central line associated bacteremia.  Another had gone 461 days without a central line associated bacteremia.  Our third ICU is currently at 647 days without a central line associated bacteremia.

[3/13/07]

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Butler Memorial Hospital – Butler, PA
Availability Status: Available to answer requests
Licensed Beds: 234
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Diane Wilson
Mentor Contact Email: dlw.nur@butlerhealthsystem.org
Mentor Contact Phone: 724-284-4862

Additional Information:

• By using small, rapid tests of change, we were able to implement the use of perfect barrier precautions by physicians.
• Increased understanding of importance of measurement to demonstrate outcomes.
• Developed an electronic documentation and data collection tool to capture physician-specific insertion data on compliance with all barrier precautions.  Individual feedback on performance given to physicians.
• "No blame" culture has improved compliance with submission of observation data.
• Implemented a "Care of the Central Line" Mediasite™ education program which provides easily accessible visual resource for staff.  This is available at every worksite for reference 24 hours a day.  This site has been a positive resource for the staff who have expressed overwhelming support of having educational resources available at the bedside.

• Reduced number of Central Line Infections from 1.6/1000 central line days to 1.1 infections/1000 central line days.
• Achieved a relative reduction of 31% or reduced the number of CLABS from 10/year (.83 annualized) to 6.6/year.
• Reduced the cost of CLABS from $250,000/year (*costs as reported by provider) to $156,000/year resulting in a savings of $93,500.
• As a result of this initiative, CLAB-associated mortality was reduced at Butler Memorial Hospital from 1 patient/year to 1 patient in 18 months
• Increased the use of perfect barrier precautions by all physicians inserting central lines from 7.4% to 84.7%.  An increase of 77.3%.

[6/2/06]

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Cape Coral Hospital – Cape Coral, FL
Availability Status: Available to answer requests
Licensed Beds: 281
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: September 2004
Mentor Contact Name: Annette Forlenza
Mentor Contact Email: annette.forlenza@leememorial.org
Mentor Contact Phone: 239-574-0159

Additional Information:

May 2009 - October 2009 :  CLBSI bundle compliance = 96%

May 2009 - October 2009 : CLABSI RATE = 0.81

Number of Days since last Episode (Mean time before failure) = 176 days

Cape Coral Hospital began its work 4 years ago with the goal to reduce CLBSI by 50%.  As with our other measures, we had issues with data collection and validity and were able to resolve these by using the change package.  We developed a data collection tool to monitor bundle compliance and communicated the standards to the appropriate practitioners.  Using PDSA cycles, we developed a barrier kit for ease of gathering items, a dressing kit and a process to report suspected infections to the IC nurse.  We were successful in meeting our goal of 50% reduction in CLBSI in our unit, and at one point had a 19 month stretch with zero CLBSI.  We have high reliability with the central line bundle and are in the process of spreading to those areas (PACU, ED) where lines may be placed.

For more information (including charts), see the July 2008 Cape Coral Hospital Improvement Report

Mentor designation - 2/14/06
Information updated - 1/15/10

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Centra Health – Lynchburg, VA
Availability Status: Available to answer requests
Licensed Beds: 517
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: July 2005
Mentor Contact Name: Kathy Bailey, RN, CIC, Director of Infection Control
Mentor Contact Email: kathy.bailey@centrahealth.com
Mentor Contact Phone: 434-200-7780

Additional Information:

Keys to success:

1) Hardwiring all elements of the insertion bundle.
2) Adding a full body drape to the central line insertion kit.
3) Educating nursing on the care of the line, i.e. ensuring that dressings are occlusive and the hub ports are disinfected prior to line access.
4) Daily discussion during rounds regarding the continued need for each line in the unit.
5) Feedback to staff directly involved in the care of a patient who develops a CL-BSI.  We ask that the chart be reviewed for GAPS (generally accepted performance standards) and corrective action taken to prevent future infections when GAPS omitted.  We ask that the case be discussed in staff meetings or huddles to "personalize" the infection to staff who may have cared for the patient and their line.

July - December 2009 rate of CL-BSIs per 1,000 line days in our adult critical care units: 0.39 Cl-BSIs/1,000 line days.  This represents one CL-BSI in the 6 month period in all 6 adult critical care units.  Centra Health's CL-BSI rate was at 3.7/1,000 line days prior to bundle implementation.

Mentor designation - 4/28/07
Information updated - 3/16/10

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Children's Healthcare of Atlanta at Egleston – Atlanta, GA
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 216
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: May 2005
Mentor Contact Name: Amber Cocks
Mentor Contact Email: amber.cocks@choa.org
Mentor Contact Phone: 404-785-7469

Additional Information:

Children's Healthcare of Atlanta began our reducing Catheter-associated Blood Stream Infections initiative in the PICU at both of our facilities, Egleston and Scottish Rite.  Our BSI Task Force, composed of front line staff and multi-disciplinary members, embraced the Central Line insertion and maintenance bundles and other components of the change package.  Unit champions took the information back to their areas and were instrumental in the success of this performance improvement initiative.  In the beginning of 2006, we spread the improvement to the NICU, TICU, and CICU.

The PICUs began by monitoring their CVL insertion and maintenance compliance in May of 2005.  The goal was to have an observer for all insertions and dressing changes and compliance was tracked and trended.  For 2007, the PICUs Insertion Bundle Compliance is 93% and Maintenance Bundle Compliance is 99% with both the insertion and maintenance bundles.

We have experienced a great deal of success in reducing our Catheter-associated BSI rates in the PICU, since implementing the bundles in May 2005.  There has been a 53% rate reduction and we have avoided 27 Catheter-associated Blood Stream Infections.

[7/7/07]

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Children's Healthcare of Atlanta at Scottish Rite – Atlanta, GA
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 234
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: May 2005
Mentor Contact Name: Amber Cocks
Mentor Contact Email: amber.cocks@choa.org
Mentor Contact Phone: 404-785-7469

Additional Information:

Children's Healthcare of Atlanta began our reducing Catheter-associated Blood Stream Infections initiative in the PICU at both of our facilities, Egleston and Scottish Rite.  Our BSI Task Force, composed of front line staff and multi-disciplinary members, embraced the Central Line insertion and maintenance bundles and other components of the change package.  Unit champions took the information back to their areas and were instrumental in the success of this performance improvement initiative.  In the beginning of 2006, we spread the improvement to the NICU, TICU, and CICU.

The PICUs began by monitoring their CVL insertion and maintenance compliance in May of 2005.  The goal was to have an observer for all insertions and dressing changes and compliance was tracked and trended.  For 2007, the PICUs Insertion Bundle Compliance is 93% and Maintenance Bundle Compliance is 99% with both the insertion and maintenance bundles.

We have experienced a great deal of success in reducing our Catheter-associated BSI rates in the PICU, since implementing the bundles in May 2005.  There has been a 53% rate reduction and we have avoided 27 Catheter-associated Blood Stream Infections.

[7/7/07]

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Cincinnati Children's Hospital Medical Center – Cincinnati, OH
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 511
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: June 2004
Mentor Contact Name: Uma Kotagal, MD, Sr. Vice President for Quality and Transformation
Mentor Contact Email: uma.kotagal@cchmc.org
Mentor Contact Phone: 513-636-0178

Additional Information:

Keys to success:

• "Real time" reporting of infections to units
• Continuous learning culture
• Preoccupation with failure - Study each infection
• Monthly organizational meetings
• Maintenance bundle compliance audits

Performed house-wide surveillance of central lines.  Baseline data for CVC-associated infections for the hospital was 3.0 per 1,000 device days in 2003. 

August 2004 - Revised procedures and implemented CDC recommendations related to site care and administration system including the use of CHG to prep site organization wide.

November 2004 to March 2005 - Implementation of Maximal Sterile Barrier recommendations from CVC and use of CHG for skin prep prior to insertion across organization.

March 2005 to December 2005 - Focus on improving reliability of care and insertion practices through work in the PICU as part of a CHCA CVC Collaborative.

May to Sept 2005 - New MaxPlus cap (positive pressure valve) trialed.  Showed dramatic increase in rates during those months.  However, infections per MaxPlus cap day increased on some units but not on others.  Cap removed from organization September 16, 2005.  Infections rate per 1,000 device days in the 6 months after the trial decreased to 2.3.

March 2006 - Refocused work of the HemOnc/BMT areas, the short-gut population, the ICUs and the NICU into a collaborative.  Each group was focused on a separate high risk population.

June 2006 - Biopatch roll-out to all units except NICU.

October 2006 - PICU and CICU joined NACHRI collaborative.  Both units had a significant decrease in BSIs.

March 2007 - BSI bundle rolled out to entire hospital.

July 2008 - NICU began use of biopatch.

January 2008 - Began using CHG for line entries in PICU and rolled out to all units by October 2008.

January to March 2009 - Rolled out use of microclave cap to all units.

Jan 2010 - Recent efforts have focused on improving compliance with the bundle, CHG baths in the PICU, and use of Sorbaview Shield.

January-December 2009 rate is 0.9 per 1000 device days.

As of the end of December 2009, we have been at or below our goal of < 1 BSI/1000 line days for the past 9 months.

Mentor designation - 5/12/06
Information updated - 3/12/10

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Claxton-Hepburn Medical Center – Ogdensburg, NY
Availability Status: Available to answer requests
Staffed Beds: 129
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: March 2005
Mentor Contact Name: Jennifer S Shaver, RN  NM/ICU, Manager/Respiratory Services
Mentor Contact Email: jshaver@chmed.org
Mentor Contact Phone: 315-393-3600 ext. 5337

Additional Information:

• In January of 2006, our 100 K Lives team met to address standardization of ICU Central Line Bundle.  We included our Chief of Surgery, and the other 3 physicians who placed central lines in ICU patients
• Expanded to involve Interventional Radiologist, Manager/Radiology and RN/Radiology.
• Central Line Bundle implemented in OR, Med Surg, and Radiology.
• We quickly implemented a QA form to be done on insertion, capturing the elements of performance key to preventing infection.
• We modified the documentation in ICU to include daily review of line necessity.

• No BSRCLIs in ICU for 3 years, 1 in 7/07 (despite compliance with elements of performance), none further ytd.
• Increase in compliance with central line bundle from 22% to 100% from 3/06 to 2/07.
• 2007 VHA Award for Clinical Excellence.

[3/6/08]

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Columbus Regional Hospital – Columbus, IN
Availability Status: Available to answer requests
Licensed Beds: 325
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: 2005
Mentor Contact Name: Jennifer Dunscomb
Mentor Contact Email: jdunscomb@crh.org
Mentor Contact Phone: 812-376-5575

Additional Information:

98% compliance with BSI bundle indicators throughout organization
 
0 BSI for > 36 months

• Developed a standardized central line cart that includes all components of the indicators.
• Revised nursing computerized documentation to count line days.
• Added line days and appropriateness of lines to daily round discussion addressed by nursing.
• Integrated checklist that is completed with every line insertion into daily charting.
• Composite reports are administered to physicians based on rates.
• Added to leadership score cards and quarterly board reports.

Mentor designation - 10/28/06
Information updated - 02/10/10

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Community Hospital South – Indianapolis, IN
Availability Status: Available to answer requests
Licensed Beds: 150
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: September 2004
Mentor Contact Name: Cleo Ann Burgard
Mentor Contact Email: cburgard@ecommunity.com
Mentor Contact Phone: 317-621-5329

Additional Information:

This intervention is spread throughout our five (5) Network hospitals: Community Hospital Anderson, Community Hospital East, Community Hospital North, Community Hospital South, and the Indiana Heart Hospital

• Formed multidisciplinary team to formulate central line insertion pack to be used with all central line insertions in the ICU
• Successfully implemented central line insertion pack in the ICU utilizing evidenced-based practices
• Implementation of the central line insertion pack along with the IHI bundle components decreased variability among physicians inserting central lines in the ICU
• The central line bundle is now being spread to other areas of the Network (i.e. Emergency Departments and Med Surg)
• Increased physician and staff satisfaction through use of the central line pack by having all components together
• After implementation of the central line bundle, line-related blood stream infections were decreased by 70% in the ICU

[2/14/06]

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Cooley Dickinson Hospital – Northampton, MA
Availability Status: Available to answer requests
Licensed Beds: 125
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: 2002
Mentor Contact Name: Tammy Cole-Poklewski, RN, MS
Mentor Contact Email:  Tammy_Cole-Poklewski@cooley-dickinson.org
Mentor Contact Phone:  413-582-4736

Additional Information:

Cooley Dickinson Hospital implemented the components of the bundle including creating a central line insertion kit which included all necessary components (except gloves) to facilitate compliance.  In 2005, an ICU rounding/goal setting form to track daily rounding was developed which prompts for appropriate care, including questioning whether the central line is still needed.

It was 967 days since last infection until 10/2/2005 when a central line infection occurred in the ICU.  There have been no further infections since that time.

[6/10/06]

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Evangelical Community Hospital – Lewisburg, PA
Availability Status: Available to answer requests
Staffed Beds: 135
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: June 2005
Mentor Contact Name: N. Richard Anderson, RN, CRNI
Mentor Contact Email: nanderson@evanhospital.com
Mentor Contact Phone: 570-522-2000

Additional Information:

In 2004, a positive trend was identified with an average of 1.5/1000 line days.  This trend continued in 2005 with 455 days without a line infection.  The Central Line Bundle Program was implemented during this period.  Hospital-wide, one line infection was noted in April 2006 followed by a 0.0/1000 rate to present.

Keys to our success:

•  IV Therapy and Infection Control collaborated on surveillance, data collection and reporting methods. 
•  A physician champion was integral to overseeing Catheter-Related Blood Stream Infections, working as a liason with the Medical Staff.
•  Implementation of a hospital-wide educational program on the Central Line Bundle for physicians and nursing staff was instituted in 2005.
•  IV team current practice includes a greater responsibility for assessment and placement of PICCs.
•  Central Line Bundle process is monitored by staff assisting physician with insertion. Bundle compliance is reviewed at several levels including Infection Control and Administration.
•  Positive outcomes were noted withing the first six months of implementation and have since been recognized locally and nationally.
•  A continous monitoring of review of processes is essential to maintain zero infection rate.
•  We have been able to sustain our successful outcomes since 2006 through the continued education of new staff on the Central Line Bundle protocol; strict monitoring of compliance with line insertions via observation and accountability; and having an IV team provide all routine central line maintenance, as well as having the IV team place most central lines through the insertion of PICC lines.

For more information on how Evangelical Community Hospital has gone for over three years without a central line infection, read the entry that won them the Hospital Association of Pennsylvania's 2009 Patient Safety Award.

Mentor designation - 4/10/08
Information updated - 2/19/10

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Exempla Saint Joseph Hospital – Denver, CO
Availability Status: Available to answer requests
Licensed Beds: 565
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2003
Mentor Contact Name: Maria Kinsella
Mentor Contact Email: kinsellam@exempla.org
Mentor Contact Phone: 303-866-8514

Additional Information:

Exempla Saint Joseph Hospital participated in the VHA Transformation for the ICU program and started work on catheter-related blood stream infections in 2003.

Keys to our success:
• Implementation of a kit providing all necessary barrier equipment.
• Adding a documentation form to the kit as a reminder of all key elements.
• A united physician front including surgeons and emergency physicians and support provided by the intensivists.

During 2005, we went housewide with the barrier kit and documentation form to include OR and ED.  Nursing and physicians have all been inserviced on the use of these tools.  We also instituted an aggressive handwashing campaign which we believe has helped reduce infection overall.

For 2005 total, our ICU had only 2 catheter-related blood stream infections!  That means 10 months of zero infections and 0.94 per 1000 patient line days!

[2/14/06]

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Henry Ford Hospital – Detroit, MI
Availability Status: Available to answer requests
Licensed Beds: 904
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2004
Mentor Contact Name: Jack Jordan
Mentor Contact Email: jjordan1@hfhs.org
Mentor Contact Phone: 313-874-3925

Additional Information:

Initial efforts to reduce bloodstream infection rates by switching to chlorhexidine skin prep and developing a line kit with all required materials were offset by the introduction of a valve-based, needle-less system. 

After a year, the system was replaced with a traditional needle-less line system.  This resulted in a total turnaround in bloodstreams infections.  In addition, reductions in bloodstream infections have continued based on education reinforced by tracking of compliance with line placement bundle.

Our aim at Henry Ford Hospital is to eliminate blood stream infections.  In order to accomplish that goal efforts are under way with a number of key innovations:

• An interactive CD ROM to improve medical education related to central lines. 
• A simulation-based training program for all medical staff.
• Development of a line placement team to ensure a high level of experience.
• Focused education on line maintenance with audits of nursing practice.

• Blood stream infections in the ICUs over the last 8 months at 0.74 per 1000 line days compared with a NNIS 10th percentile of 1.7 per 1000 line days for major teaching hospital ICUs.
• Two Months with no infection in an adult ICU (Over 4000 line days)
• Line placement audits show compliance of 97% in our latest audit.

[1/31/06]

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Johns Hopkins Children's Center of the Johns Hopkins University – Baltimore, MD
[Pediatric Mentor]

Availability Status: Available to answer requests
Licensed Beds: 170 pediatric beds
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: February 2004
Mentor Contact Name: Marlene Miller
Mentor Contact Email: mmille21@jhmi.edu
Mentor Contact Phone: 443-287-5365

Additional Information:

We have successfully deployed an initiative aimed at improving practice around insertion of pediatric central lines in the PICU.  This involves doing the Central Line Bundle (tailored for children) coupled with a dedicated central line cart and teamwork/empowerment building of PICU staff.  These efforts have led us to discover and remove a central line cap that was causing blood stream infections and helped us identify the need for focused efforts in ideal practices surrounding maintenance of central lines.

Removal of the offending central line cap decreased our BSI incidence from 2-3 cases per month to 0-1 cases per month.

[4/17/06]

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Lancaster General Hospital – Lancaster, PA

Availability Status: Available to answer requests
Staffed Beds: 606
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2006
Mentor Contact Name: Wendy Fitts
Mentor Contact Email: wsfitts@lancastergeneral.org
Mentor Contact Phone: 717-544-1981

Additional Information:

Keys to success:

• Insertion of PICC lines by the designated IV team nurses who have maintained strict compliance to all components of the central line bundle including full body drape, use of PPE and appropriate skin cleansing technique.  The skill level of these nurses in their ability to insert these lines has dramatically decreased our need for subclavian catheter insertions for medication administration.
• Development and implementation of a line surveillance team who monitors necessity of central lines, as well as implementation of multidisciplinary rounds in the ICU with daily goals.

Outcome measure: Entire facility had six consecutive months of zero catheter associated blood stream infections during the past fiscal year.

Process Measure: 98% compliance facility-wide with the insertion piece of the central line bundle over the past fiscal year.

[12/05/08]

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North Shore University Hospital– Manhasset, NY
Availability Status: Available to answer requests
Licensed Beds: 849
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: October 2005
Mentor Contact Name: Donna Armellino, RN, DNP, CIC
Mentor Contact Email: darmelli@nshs.edu
Mentor Contact Phone: 516-562-3573

Additional Information:

North Shore University Hospital developed a standardized approach to manage the process of care and control the incidence of central line infections.  A multidisciplinary Nosocomial Infection Steering Committee ensures that there is “zero tolerance for hospital-acquired infections” by providing oversight to the Central Line Infection Taskforce regarding recommendations for targeted improvement efforts and the establishment of consistent data definitions for central line associated bacteremia (CLAB).  The goal of this initiative was to develop accountability and change behavior of clinicians at the bedside to reduce CLABs. 

Objectives used to reach this goal include:
• Implement standardized, evidence-based reduction strategies
• Increase communication, therefore raising consciousness of the caregiver
• Establish new educational forums for improvement
• Standardize reporting by creating metrics to demonstrate the results of the infection measures in quality forums

Education, communication, and weekly prevalence studies of the infection prevention practices was key in the success of this initiative.

Partners: Infection control, quality management, nursing, medical staff, administration, laboratory, materials management, pharmacy, and safety professionals. 

Standardized Tools: 
• A Central Line Insertion Note was created and is a required element of the patient’s chart.
• A Central Line Insertion Kit, complete with the required chlorhexidine skin prep, is used for every procedure.
• A Central Line Insertion Policy was developed.

Educational Resources:
• An IHI Nursing Module was created along with a pre and post-test, and incorporated into Nurse Manager Training Sessions.
• A Physician Central Line Insertion PowerPoint was created along with a pre and post-test.
• A Central Line Insertion Video was created in our simulation lab that includes all of the bundle components.
• An IHI 100K Lives Campaign page was created on our intranet that includes all of the items above along with links to Institute for Healthcare Improvement (IHI), Healthcare Association of New York State (HANYS) and the Greater New York Hospital Association-United Hospital Fund CLABs Collaborative.

Awareness & Recognition: 
• Several articles were written in a publication mailed to all employees to increase awareness of the initiative.
• IHI Awareness Posters are displayed throughout the hospital.
• IHI initiative information was included in the staff training for Patient Safety Week 2006.
• Members of the Central Line Insertion Task received a Certificate of Appreciation.

Lessons Learned:
• Defined direction and commitment from all leadership made the initiative successful.
• Central approach to defining measures created consistency.
• Involvement of health care providers at every level helped to reduce variation in care.
• Formal education increased understanding of practice.
• Monitoring and objective feedback helped to change behavior not just compliance with documentation.

Outcomes: The infection prevention initiative revealed a decrease in CLABs.
• From October 2005 to May 2006, central line bundle compliance remained at 100%. • From February 2004 to April 2006, the bacteremia index decreased from 3.15 to 1.27.

[8/4/06]

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Northwestern Memorial Hospital – Chicago, IL
Availability Status: Available to answer requests
Licensed Beds: 811
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Bob Costello
Mentor Contact Email: rcostell@nmh.org
Mentor Contact Phone: 312-926-4714

Additional Information:

(1) Implemented Central Line Bundle in all ICUs
• Hand hygiene
• Maximal barrier precautions
• Chlorhexidine skin antisepsis
• Optimal catheter site selection, with subclavian vein as the preferred site for non-tunneled catheters
(2) Trained Medicine residents in line insertions techniques using simulation lab
(3) Purchased and stocked sterile procedure carts for each ICU

Successful Implementation and Spread Strategies

(1) Infrastructure
• VP leadership support/Physician champion
• Monthly Critical Care Leadership meeting
• Project accountability (Bi-monthly presentations to Executive Leadership)
• Hospital support/resources
(2) Implementation occurred on entire unit at the same time
(3) Efforts were communicated to entire care team (medical staff, nursing, respiratory care and pharmacy)
• Close to 90% compliance with central bundle in all 5 ICUs
• Decreased hospital CVC infection rate by almost 30% in the first quarter of implementation

[1/31/06]

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Our Lady of Lourdes Memorial Hospital – Binghamton, NY
Availability Status: Available to answer requests
Licensed Beds: 267
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: June 2004
Mentor Contact Name: Jill Patak, RN   Quality Engineering Specialist
Mentor Contact Email: jpatak@lourdes.com
Mentor Contact Phone: 607-798-5881

Additional Information:

We joined the IHI Breakthrough Series to prevent central line infections in ICU.  The team reviewed the central line bundle checklist and adapted it to meet our needs.  A central line cart was placed in ICU that had the central lines, sterile gown, sterile gloves, caps and masks, the CDC guidelines for insertion of central lines, as well as the checklist to be completed by the RN.  A letter was sent to all medical staff advising that the CDC guidelines will be followed and a checklist was created for this purpose, and the letter was signed by the ICU Medical Director as well as the Infectious Disease physician.  We began testing in ICU in June 2004, with one ICU RN and one physician.  This was a difficult time and the RNs felt that they were being the "police."  Over time, we had our sterile processing department put together central line kits which included everything necessary to place a central line including the checklist.

Prior to implementing the bundle, a timeframe of 9 months (6/03 - 3/04), showed our central line infection rate as 15.3.

After implementing the central line bundle, again using the same 9 month period (6/04 - 3/05), our central line infection rate decreased to 5.8%.  Overall we had a 62% reduction in our central line infection rate in ICU.

To compare calendar years and the ICU central line infection rates:
2004: 8.7% per 1000 central line days.
2005: 2.96% per 1000 central line days.

[1/31/06]

*                *                  *

Overlake Hospital Medical Center – Bellevue, WA
Availability Status: Available to answer requests
Licensed Beds: 337
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: October 2004
Mentor Contact Name: Stephanie Crow
Mentor Contact Email: Stephanie.crow@overlakehospital.org
Mentor Contact Phone: 425-688-5310

Additional Information:

Keys to success:

• Culture of critical care: Staff improved critical thinking and planning for patient care
• Staff are able to keep in mind continuum of care for the patient, rather than just what is taking highest priority at that moment.
• Belief that infections are not inevitable
• Spread central line bundle checklist to all areas of hospital where central lines are inserted
• Creating "Insertion Carts" that are distributed & stocked by distribution department assures all key elements--including checklist--are available to physician and staff for the insertion.

Because research shows that a higher percentage of patients develop CLRBSI outside of critical care than in, our Infection Control department keeps track of every central line insertion throughout the hospital, not just in Critical Care.  Our bundle compliance for all central line insertions is 97.65% appropriate care score, or ACS.  This means that only patients who received 100% of the bundle are counted.  If even one element is missing, that is a fallout.

12 m Baseline average CA-BSI rate 2.84
12 m project average CA-BSI rate .73 = 74% Reduction
Most current 12 m data: 3 infections per 3801.294 central line days = 0.78 CA-BSI rate

Mentor designation - 1/31/06
Information updated - 11/13/09

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Peace Health/St. Joseph Hospital – Bellingham, WA

Availability Status: Available to answer requests
Staffed Beds: 243
Teaching / Non-Teaching Status: Non-Teaching
Setting: Rural
Start Date of Intervention Work: October 2005
Mentor Contact Name: Becky Stermer, RN, BSN, Critical Services Outcome Coordinator
Mentor Contact Email: bstermer@peacehealth.org
Mentor Contact Phone: 360-738-6300 ext. 2455

Additional Information:

Our strategy for eliminating central line infections was to create a culture of mutual accountability for safety and reliability, as our vision states, "every touch, every time."  Initial audits of our compliance with strict sterile technique revealed surprising lapses.  We made several process improvements:

• We re-educated physicians, nurses and other healthcare workers to feel empowered to stop a procedure if unsafe practices were witnessed.
• Created a Central Line Bundle Audit checklist for RNs to fill out each time a line was placed.  The checklist is printed on bright fuchsia paper, and is attached to the top of every central line insertion kit by central supply.
• Stocked the Central Line Insertion Cart and bedside nurse server carts with chlorhexidine and removed all Betadine from the carts and from the ICU central supply stock rooms.

Our aim was to:

1) Reduce the incidence of central line bloodstream infection to zero or have 300 days between infections by July 2007

2) Achieve Central Line Bundle compliance in 95 percent of cases.

From May 2006 through April 2007, we had 334 days without a central line bloodstream infection.  We had a particularly difficult fourth quarter of 2007, with one infection in each of the three months.  We have renewed our emphasis on central line maintenance, as our insertion bundle compliance has been at 100% since April 2008.  As of 11/20/08, we are at 78 days without a central line infection.  We have had a total of 2 central line associated blood stream infections so far in 2008, for a rate of 0.5% per 1000 catheter days.

These changes in our processes for the most part did not require additional resources or technology.  They were implemented through a series of small tests of change and relentless consistency of focus.  We now drill down on a case-by-case basis when we see an infection, and look for opportunities to add redundancy or improve the reliability of our processes.  We are constantly striving to make best practice the default.  We continue to foster a culture of zero tolerance for any hospital-acquired infection.

For more information (including charts), see the April 2008 PeaceHealth/St. Joseph Hospital Improvement Report

[12/05/08]

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Plainview Hospital – Plainview, NY
Availability Status: Available to answer requests
Licensed Beds: 239
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: October 2005
Mentor Contact Name: Donna Kube, RN
Mentor Contact Email: DKube@nshs.edu
Mentor Contact Phone: 516-719-2251

Additional Information:

Plainview Hospital developed a standardized approach to manage the process of care and control the incidence of central line infections.  A multidisciplinary Nosocomial Infection Steering Committee ensures that there is “zero tolerance for hospital-acquired infections” by providing oversight to the Central Line Infection Taskforce regarding recommendations for targeted improvement efforts and the establishment of consistent data definitions for central line associated bacteremia (CLAB).  The goal of this initiative was to develop accountability and change behavior of clinicians at the bedside to reduce CLABs. 

Objectives used to reach this goal include:
•  Implement standardized, evidence-based reduction strategies
•  Increase communication, therefore raising consciousness of the caregiver
•  Establish new educational forums for improvement
•  Standardize reporting by creating metrics to demonstrate the results of the infection measures in quality forums

Education, communication, and weekly prevalence studies of the infection prevention practices was key in the success of this initiative.

Partners: Infection control, quality management, nursing, medical staff, administration, laboratory, materials management, pharmacy, and safety professionals. 

Standardized Tools: 
•  A Central Line Insertion Note was created and is a required element of the patient’s chart.
•  A Central Line Insertion Kit, complete with the required chlorhexidine skin prep, is used for every procedure.
•  A Central Line Insertion Policy was developed.

Educational Resources:
•  An IHI Nursing Module was created along with a pre and post-test, and incorporated into Nurse Manager Training Sessions.
•  A Physician Central Line Insertion PowerPoint was created along with a pre and post-test.
•  A Central Line Insertion Video was created in our simulation lab that includes all of the bundle components.
•  An IHI 100K Lives Campaign page was created on our intranet that includes all of the items above along with links to Institute for Health Care Improvement (IHI), Healthcare Association of New York State (HANYS) and the Greater New York Hospital Association-United Hospital Fund CLABs Collaborative.

Awareness & Recognition: 
•  Several articles were written in a publication mailed to all employees to increase awareness of the initiative.
•  IHI Awareness Posters are displayed throughout the hospital.
•  IHI initiative information was included in the staff training for Patient Safety Week 2006.
•  Members of the Central Line Insertion Task received a Certificate of Appreciation.

Lessons Learned:
•  Defined direction and commitment from all leadership made the initiative successful.
•  Central approach to defining measures created consistency.
•  Involvement of health care providers at every level helped to reduce variation in care.
•  Formal education increased understanding of practice.
•  Monitoring and objective feedback helped to change behavior not just compliance with documentation.

Outcomes:  The infection prevention initiative revealed a decrease in CLABs. 
• From October 2005 to July 2006, the Central Line Bundle compliance remained at 100%.
•  From October 2004 to July. 2006, the bacteremia index decreased from 1.4  to 1.3.

[8/15/06]

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Prince William Hospital – Manassas, VA
Availability Status: Available to answer requests
Licensed Beds: 170
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: January 2006
Mentor Contact Name: June Lyda, Performance Improvement Manager
Mentor Contact Email: jlyda@pwhs.org
Mentor Contact Phone: 703-369-8824

Additional Information:

Prince William Hospital implemented customized dressing kits for all patients in the Critical Care Unit with Central Lines.  Compliance with the bundle has been accomplished with buy-in from stakeholders, including ICU nursing staff.  The ICU nursing staff was included at the onset of implementation and have been instrumental in establishing documentation.  Also, a checklist is being implemented electronically as part of documentation for the bundle.  Strong education and communication to staff and physicians has been key to our success.

The bacteremia rate per 1000 line days reduced from 14.5 to 0.0 over a nine month period.

In First Quarter 06 a total of 330 central line days with no CL infections (0%) was recorded with 100% receiving all five elements of the bundle.

[6/2/06]

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River's Edge Hospital & Clinic – St. Peter, MN
Availability Status: Available to answer requests
Licensed Beds: 22
Teaching / Non-Teaching Status: Non-teaching
Setting: Rural
Start Date of Intervention Work: March 2005
Mentor Contact Name: Benjamin W. Chaska, M.D., MBA, CPE, FACPE, Chief Medical Officer and Patient Safety Officer
Mentor Contact Email: bchaska@riversedgehealth.org
Mentor Contact Phone: 507-934-8416

Additional Information:

Adaptation: Reliable Use of Peripheral, Pic and Central Line Bundles

Actions Taken:

• Standardized IV bundle implemented throughout hospital
• Adopted IV start kit
• Standardized IV start documentation
• IV competency (use of bundle and documentation) audit implemented for all RNs

Results: There have been no intravenous line infections or phlebitis in the past year.

Mentor designation - 1/31/06
Information updated - 2/22/10

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Rochester General Hospital – Rochester, NY
Availability Status: Available to answer requests
Licensed Beds: 528
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2004
Mentor Contact Name: Linda R Greene, RN, MPS, CIC
Mentor Contact Email: linda.greene@viahealth.org
Mentor Contact Phone: 585-922-5607

Additional Information:

Our project was to develop an organization-wide approach to the prevention of central line-associated bacteremia through a collaborative multidisciplinary effort, which focused on evidence-based literature, best practices, and process improvement.  Our process included a comprehensive literature review, internal practice analysis, and development of practical experience through rapid cycle change, subsequent analysis and feedback.  In addition to implementation of the bundles, we developed learning modules for staff and included central line care as part of core nursing competency.  Additionally, we expanded the role of the IV team to assume care and maintainence of all central lines outside of the ICU.

Dramatic results were realized within the first 3 months of instituting the organization-wide program.  We experienced a 50% reduction in catheter-associated bloodstream infections.  Ongoing, sustainable, and significant reductions have been achieved.  Prior to implementation there were 119 line-associated bacteremias in 17,224 line days (rate of 6.9 per 1,000 line days).  Attributable mortality was 3.4%.  At the end of the following year, there were 62 bacteremias in 16,093 line days (rate of 3.9 per 1,000).  Attributable mortality was zero.  Reduction was statistically significant (p = .0002).  Cost avoidance was estimated at $408,000 -$1,685,000.  By 2006, our rate had dropped by 72% to a rate of 1.7 per 1,000 line days.  The target unit, our Medical ICU, had a rate of zero for 11 consecutive months.

[8/31/06]

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Sacred Heart Medical Center – Spokane, WA
Availability Status: Available to answer requests
Licensed Beds: 623
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2005
Mentor Contact Name: Denise Dominik
Mentor Contact Email: dominid@shmc.org
Mentor Contact Phone: 509-474-3733

Additional Information:

Keys to our success in preventing central line infections:
1.  This was a previous project done in the late 1990's with great success in reducing our rate of infection.  We then added the use of chlorhexidine and full drape.
2.  We have a nurse vascular access team that places Peripherally Inserted Central Catheters (PICC) which is highly utilized and has contributed to decreased infection rate.
3.  Our infection control department is very involved in product evaluation as well as ongoing monitoring for infections.
4.  Our Vascular Access Team has done all central line dressing changes so highly competent nurses consistently perform this function.
5.  We also have an active City-Wide Infection Control Committee that works across the city to standardize policies/procedures which is a great help in gaining physician support.

We also use standardized carts that are exchanged in our central distribution area - the ICU's have special carts with additional items and the house-wide cart is standardized with the bundle items.  We also use central line checklists on top of our line carts so it is right there with them.

Our infection rate for 1st quarter 2005 dropped to 1 infection per 1000 as compared to the CDC rate of 3 per 1000.  Remeasure is under way.

[4/17/06]

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St. Catherine of Siena Medical Center – Smithtown, NY
Availability Status: Available to answer requests
Licensed Beds: 311
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Catherine Shannon, RN, FNP, Director, Infection Control
Mentor Contact Email: catherine.shannon@chsli.org
Mentor Contact Phone: 631-862-3541

Additional Information:

We have educated medical and nursing staff on importance of strict hand hygiene and daily care of the Central Lines in ICU and CCU.  We have established daily multidisciplinary team rounds to review all aspects of the bundle for each patient with a central line.  We have revised IV Therapy policies and procedures, eliminated inappropriate use of femoral lines, and increased the use and availability of PICC lines.

For the past 5 months, we have had 0 CRBSI in the ICU and CCU.

[3/30/06]

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Saint Elizabeth Regional Medical Center – Lincoln, NE
Availability Status: Available to answer requests
Licensed Beds: 242
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2004
Mentor Contact Name: Lori L. Snyder-Sloan, RN MSN, CIC, Infection Prevention and Safety Coordinator
Mentor Contact Email: LSnyder@stez.org
Mentor Contact Phone: 402-219-7333

Additional Information:

Physicians were informed by letter (signed by the Chief of Staff, CMO and CCU Medical Director) of the CDC recommendations for attire during insertion of central lines, and notified that this standard of care would be enforced in the Critical Care Unit by the nurses assisting with the procedure.  Outliers were contacted by the CMO.

All nurses in each of our adult critical care units were required to complete online education and testing for infection prevention during cental line usage, using materials modeled after the Barnes-Jewish WAHP VAP program. 

Every day in rounds the question, "Do we still need the central line?" is asked.  Pharmacy, the primary nurse, dietary and the intensivist collaborate to evaluate patient needs for continued central venous access.

When Chloraprep (CHG) was introduced to the market, we began using this for site preparation prior to insertion.  In the CCU, we also began using CHG for port access.

CCU central line dressing changes are done every 0-3 days at the nurse's discretion with the provider wearing sterile gloves, hat and mask.

CCU posts "Days Since" CLI on the unit.  In addition, "Days Since" CLI for all critical care units (CCU, Burn and NICU) are published in each employee newsletter.  Rates of CLI are also included in the dashboard report given during each monthly staff meeting throughout the hospital.  Communication of outcomes has enhanced staff engagement and pride in the process.

From January 2004 through January 2007 our 12 month cumulative mean for CLI plummeted from 5.5/1000 to 0.5/1000 central line days.  The majority of the improvement occurred during the final 12 months.

In 2006, we experienced 344 days without a Central Line Infection in Critical Care.

We predict we prevented one CLI and saved $15,000.  Based on data available, we anticipate that at the conclusion of the current fiscal year the results will be even more dramatic.

[3/13/07]

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St. Luke’s Hospital – Cedar Rapids, IA
Availability Status: Available to answer requests
Licensed Beds: 560
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: May 2005
Mentor Contact Name: Karen Ratz
Mentor Contact Email: RatzKJ@crstlukes.com
Mentor Contact Phone: 319-369-7178

Additional Information:

We have been successful in implementing all aspects of the central line bundle.  We implemented the checklist and check for line necessity during daily rounds on the units.  We have developed a custom kit for inserting central lines and PICC lines which contain all necessary items to place a central line.  We also have a central line dressing team that is responsible for all central line dressings.

Central line infection rate in 2005 was 0.0. PICC line infection rate was 0.43.

2006 YTD 0.0 Central line infections and only 1 PICC line infection.

[8/31/06]

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Santa Clara Valley Medical Center – San Jose, CA
Availability Status: Available to answer requests
Licensed Beds: 574
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: August 2005
Mentor Contact Name: Carolyn Brown
Mentor Contact Email: Carolyn.brown@hhs.sccgov.org
Mentor Contact Phone: 408-885-2093

Additional Information:

Santa Clara Valley Medical Center has successfully implemented the Central Line Infection bundle and has reduced the frequency of these infections to zero in the Surgical, Trauma, Coronary, and Medical Intensive Care Units and the Operating Room and Emergency Department.  An interdisciplinary physician-led team provided direction and education for staff, physicians, and managers, created central line carts to ensure that equipment required for bundle compliance is always accessible, and tracks performance and outcomes.  A letter from physician leaders in the organization to medical staff and nursing set the expectations and accountabilities for compliance.  Implementation of the bundle is now being expanded to the Burn Center, Neonatal ICU, Pediatric ICU and Medical/Surgical Units.

Santa Clara Valley Medical Center has experienced over 3,000 line days without a central line infection and has had zero central line infections for the the past six months.  There had never been a rate of zero prior to implementation of the bundle.  Frequency of compliance with all elements of the bundle continues to rise.  Use of face shields is improving but has reduced the overall percentage of total compliance, with other requirements being consistently followed.

[10/28/06]

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Sequoia Hospital – Redwood City, CA
Availability Status: Available to answer requests
Licensed Beds: 421
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: October 2003
Mentor Contact Name: Joanne Jeffords
Mentor Contact Email: Joanne.Jeffords@chw.edu
Mentor Contact Phone: 650-367-5855

Additional Information:

• Introduced the CVP Bundle in October 2003.
• Had support of Infectious Disease physician champion.
• ICU clinical nurses assisted in implementation of bundle and education of MDs and RNs.
• Added the components of the CVP Bundle to the ICU flowsheet to allow documentation of compliance.
• Gained support from the CV team.  In October 2005, they requested the bundle be used on their patients along with "teal tinted" chloroprep to improve visualization.
• Education and all CVP Bundle components provided to all nursing areas that insert central lines.
• Had not been accurately measuring BSI in CY 2003; process is now valid and reliable.
• BSI for CY 2005 ranged between 0.3-0%.
• There were 2 BSI in 2005.

*                *                  *

South Shore Hospital – South Weymouth, MA
Availability Status: Available to answer requests
Licensed Beds: 395
Teaching / Non-Teaching Status: Non-teaching
Setting: Urban
Start Date of Intervention Work: February 2003
Mentor Contact Name: John Stevenson, MD
Mentor Contact Email: john_stevenson@sshosp.org
Mentor Contact Phone: 781-624-8996

Additional Information:

South Shore Hospital has had the central line bundle in place since February 2003.  We use a cart that contains all the needed equipment and barrier precautions:  insertion kit with antibiotic impregnated catheter, chlorhexidine antiseptic, mask, gown, drapes.  There is an RN present during the procedure for observation of compliance with insertion procedures as well as patient monitoring.  We have designated the subclavian vein as the site of preference.

The need for the line is re-evaluated by the rounding team on a daily basis.  Dressing change is limited to weekly or as necessary with q shift observation for redness or drainage.  We consistently emphasize the importance of hand hygiene.

South Shore Hospital has had only 2 CL infections since putting the central line bundle in place in February 2003.

[6/2/06]

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Stony Brook University Hospital – Stony Brook, NY
Availability Status: Available to answer requests
Licensed Beds: 504
Teaching / Non-Teaching Status: Teaching
Setting: Rural
Start Date of Intervention Work: October 2004
Mentor Contact Name: Christine McMullan
Mentor Contact Email: christine.mcmullan@sunysb.edu
Mentor Contact Phone: 631-444-4709

Additional Information:

The team adopted and instituted the central line bundle (best practices) identified by IHI in the Reducing Complications in the ICU Collaborative. Included in the central line bundle are the following components: hand-washing, optimal insertion site (subclavian), wearing of full barrier protection, preparing of skin with antiseptic/detergent chlorhexidine 2% in 70% isopropyl alcohol, daily review of necessity, early removal, and antibiotic impregnated catheter. Our team also included use of the biopatch dressing as an additional element to the central line bundle.

In addition to the central line bundle, other best practices were identified to reduce complications in the ICU: the establishment of explicit daily goals for patients, and the institution of multi-disciplinary rounds to review the patients’ status and to facilitate the development and consensus of the patients’ daily goals.  The team also developed a standardized central line kit that contains all elements of the central line bundle (excluding central line and gloves due to various sizes).

Stony Brook achieved initial success in decreasing CLBSI in 2005: Eleven of the 13 months presented no catheter related blood stream infections for the Surgical ICU during the post-implementation period.

CLBSI infection rate increased in 2006/2007.  Consequently, review, standardization, and deployment of nursing and medical staff education on the care and placement of central lines during 2008, including implementing the following strategies

Developed and deployed standardized central line insertion certification program
- Administrative P & P developed for central line insertion
- Online educational module leased from Duke Medical Center
- Central line certification policy developed
- Central line competency checklist created

Developed and implemented central line maintenance protocol

Mentor designation - 1/31/06
Information updated - 9/30/08

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Swedish Medical Center – Seattle, WA
Availability Status: Available to answer requests
Licensed Beds: 697
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: March 2005
Mentor Contact Name: Will Shelton
Mentor Contact Email: will.shelton@swedish.org
Mentor Contact Phone: 206-386-2054

Additional Information:

Achieved 90% compliance with the central line bundle for lines placed in the ICU by year-end 2005.

At an overall rate of 2.2 central line associated blood stream infections per 1000 line days, near the top 10th percentile of hospitals across the nation when compared with other hospitals reporting infections to the CDC's National Nosocomial Infection Surveillance System.

Successfully employed the "one patient, one physician, one time" approach to implementing the central line bundle.

Achieved goal of standardizing central line insertion supplies across three hospital campuses and five ICUs, a challenging and very rewarding process.

Worked with supplier to create a central line bundle "kit" to be stocked in central supply for easy access to areas outside the ICU where central lines are placed, such as the operating rooms and emergency departments.

Employed numerous other strategies to reduce the risk of central line infections in addition to the bundle.

Mentor designation - 1/31/06
Information updated - 11/18/09

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Tacoma General/Allenmore Hospital– Tacoma, WA
Availability Status: Available to answer requests
Licensed Beds: 521
Teaching / Non-Teaching Status: Non-Teaching
Setting: Urban
Start Date of Intervention Work: October 2005
Mentor Contact Name: Stacy Andres
Mentor Contact Email: stacy.andres@multicare.org
Mentor Contact Phone: 253-403-1164

Additional Information:

MulitiCare Health System began its participation in the Transforming the ICU (TICU) VHA Project in 2004.  Participation in the VHA TICU project provided the opportunity for MHS staff to learn how to use evidenced-based practice to improve patient outcomes, use proven, measurable clinical practices to affect patient outcomes and use data, analysis, and parameters to make significant reductions in patient mortality, morbidity, and overall hospital costs.

To improve awareness of the Central Line bundle, team members from Critical Care and Intravenous (IV) Services worked together to develop a Vascular Catheter Insertion checklist to help standardize practice regardless of where the patient is located or who is inserting the line.  The checklist emphasizes “clean hygiene,” i.e. Full body drape for the patient, chlorhexadine, cap, mask, and gown for Licensed Individual Practitioners and assistant, appropriate hand hygiene, etc.  The form helps to empower the RN assisting to stop the procedure if clean technique is not followed and to change the practice.  We have also standardized the central line carts.

• The MHS Central Line infection rate has decreased from 1.82 per 1000 discharges in 2004 to 1.11 per 1000 discharges in 2005, more than a 38% improvement.
• There have been no instances of of Central Line Infections in the three adult critical care areas for the first two quarters of 2006.

[8/31/06]

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UMass Memorial Medical Center – Worcester, MA
Availability Status: Available to answer requests
Licensed Beds: 771
Teaching / Non-Teaching Status: Teaching
Setting: Urban
Start Date of Intervention Work: January 2003
Mentor Contact Name: Robert Klugman, MD
Mentor Contact Email: robert.klugman@umassmemorial.org
Mentor Contact Phone: 774-442-3604

Additional Information:

Our hospital has successfully deployed standard line carts, electronic checklists in the ICUs to assure proper placement of lines.  This includes empowering the nurse to stop the procedure if checklist not followed.  This checklist refers to the central line bundle.  Daily electronic MD notes documents appropriateness of the line.  A chlorhexidine sponge or gel dressing is placed over the line insertion site.  All high risk lines are flagged electronically and assessed within 24 hours.  A root cause analysis meeting is held for all CR-BSI events.  Recent discussions have indicated contaminated culture technique leading to re-education of staff drawing blood cultures.  Education to all providers who place or care for central lines has been done.

Current data on bundle compliance: 100%

Current data on number of central line catheter-related bloodstream infections per 1000 central line days:
In critical care units, FY 2009 had a 20% reduction in rates when compared to FY 2008. Our current rate/1000 pt days is <1.1.

See a graph of their results

Mentor designation - 1/31/06
Information updated - 3/4/10