Home' The Source : First Quarter 2011 Contents insertion site, hand hygiene prior to handling the
line, disinfecting the access hub before use and daily
review of central lines to remove when no longer
HCA standardized the contents of dressing change
kits based on needs identified by users. A "Rub the
Hub" campaign contributed by an ICU team at
Brandon Regional Hospital in Brandon, FL, empha-
sizes the importance of using alcohol to disinfect the
hub before accessing the central line to draw blood
or deliver medications.
"Only by e ectively putting evidence-based infec-
tion prevention strategies into practice can we reduce
health-care-associated infections," Moody says.
Team Communication and Culture
The HCA initiative also addressed the importance
of e ective communication within the clinical teams
that come together to insert and maintain central-
line catheters. Standardizing equipment and defining
evidenced-based strategies to be used each and every
time is an important first step, says Barbara Olson,
MS, RN, FISMP, director of patient safety, Clinical
Services Group, HCA.
From an engineering standpoint, this means that the
plan for central-line insertion and maintenance is cor-
rect. But executing a correct plan as intended requires
additional skills. Clinicians who carry out high-stakes
tasks must be able to recognize places where a process
deviation occurs, and be willing to speak up and take
corrective action before harm occurs.
"Central-line insertion is an invasive procedure,
carried out by humans in a wide array of complex
clinical environments," Olson says. "Deviations from
planned activities are going to occur. The problem is
not only the deviation from a mission-critical step---it's
the inability to recover when it does."
In the case of CLABSI prevention, recovery oppor-
tunities come from team members' ability to speak up
if a sterile catheter is inadvertently contaminated; if a
clinician forgets to sanitize his or her hands; or if a cap
and mask are not donned. Recovery opportunities also
exist in the maintenance phase.
Training provided to team members included both
the behavioral expectation of "speaking up" and the re-
sponse expected from the team member who may have
breached a safety standard. Everyone must be willing
to hear the concern and take corrective action.
"We were able to center team communication
around the needs of the patient, not the status or se-
niority of any individual team member," Olson says.
"The behavioral expectations stress trouble-shooting
and resolving the problem to ensure the planned care
Simplifying the Supply Chain
In addition to ensuring greater patient safety, the
use of standard prepackaged kits streamlines order-
ing, stocking and inventory controls, Moody says. It
also reduces the amount of time sta spend looking
for individual items and requesting replacements
when inventory runs low, resulting in increased ef-
ficiency and improved worker satisfaction.
Between 15 and 20 items may be needed for an
insertion. In a study and a Six Sigma project at Barnes-
Jewish Hospital in St. Louis, researchers found using
the kit eliminated 11 separate steps, including time for
ordering, stocking and charging out each item pulled
from the shelves, Moody says.
HCA also has supported standardization of periph-
erally inserted central catheter (PICC) carts. "This
makes it easy for our sta to utilize the products and
perform procedures more e ciently. It also facilitates
inventory control since the proceduralist or assistant
can see immediately how many of a given item they
have," Moody says.
Early input from physicians, nurses, technicians
and others was crucial for the successful transition to
the new procedures. "End-users are very important
partners in supply chain e orts, because the frontline
caregivers must willingly support the process. And
the supply chain side can help provide educational
resources and information from vendors when prod-
ucts change," she says.
"Everyone was generally accepting once they un-
derstood and had some experience with the new
products and kit components," she adds, especially
since the goal was to eliminate CLABSIs.
"Five or 10 years ago, it was not unusual to say
some patients with central lines develop infections,
and there is nothing we can do about it," Septimus
says. "It turns out that things we thought were not
preventable are preventable. We owe it to these
patients who put their lives in our hands to do ev-
erything we can to prevent complications while they
are in the hospital." S
The evidence is very
clear-cut that using
kits or carts significantly decreases
infections, saves time and
improves provider satisfaction."
---Julia Moody, clinical director infection prevention, Clinical Services Group, HCA
The Source | First Quarter 2011 25
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