The MICU reduced the number of CLABSIs by 50%. A consistent, comprehensive, interdisciplinary approach to assessing the central lines has allowed the MICU to more effectively assess the central lines” Murphy et al (2019).
BACKGROUND: A multidisciplinary team, including critical care nurses and specialists, critical care intensivist physicians and infection preventionists developed and implemented a new care leadership model to direct the assessment of central venous catheters and central line bloodstream infection (CLABSI) risk in a medical intensive care unit (MICU) within an academic quaternary care hospital.
METHODS: The MICU unit based clinical leadership (UBCL) introduced weekly multidisciplinary central line rounding that incorportated assessments at the bedside from physicians, nurses, advanced practice providers and infection preventionists. Each discipline assessed each patient’s central access from his or her professional perspective. This new practice widened the scope of assessments to include proper insertion practices, choice of line location and discussions about line removal. Additionally, this allowed a forum for direct feedback and discussion at the bedside and provided an opportunity for caregivers to learn from these experts. Technology supported the function of this team by introducing the use of mobile devices and?sophisticated research software providing a communication and?auditing arena. REDCap was implemented to structure the information efficiently. This allowed data to be securely accessed and completed at the bedside using a mobile phone or IPad. The team also used photographs to track their progress. “Before” and “after” photos of problematic lines visually depicted their success, and also provided education to staff in the unit newsletter, Central Line Rewind.
RESULTS: The MICU compared its CLABSI performance over a five month period in 2017 to 2018 (7/1 to 11/30). In 2017, the MICU incurred six (6) CLABSIs. In 2018, it incurred three (3).
CONCLUSIONS: The MICU reduced the number of CLABSIs by 50%. A consistent, comprehensive, interdisciplinary approach to assessing the central lines has allowed the MICU to more effectively assess the central lines. In addition, implementing a technological solution has enabled real-time peer review, including results from effective interventions.
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Murphy, L.W., Gilmar, C., Davis, C., Maillie, S., Anderson, B., Schweikert, W., LaMura, E., Tolbert, M., Kinniry, J.H., Leichter, D., Lightheart, E., Fuchs, B. and Piech, A. (2019) Innovative, Multidisciplinary Central Line Assessments in the Medical ICU (MICU): Utilizing Technology to Provide Real-time Feedback. American Journal of Infection Control. 47(6), p.S39. DOI: https://doi.org/10.1016/j.ajic.2019.04.092.