Duke Raleigh Hospital's administration supported a Six Sigma infection prevention team to address the increase in central line-associated bloodstream infections (CLABSI). The Intensive Care Unit (ICU) staff at Duke Raleigh joined the team after attending the North Carolina Quality Center collaborative meeting.

The infection prevention team, along with the ICU champion, Stephanie Johnson-Dean, RN, worked to put together a plan to adopt the proven techniques and procedures that can reduce harm to patients through central-line bloodstream infections. The ICU staff embraced the evidence-based principles, and their resulting motto was “Every Patient, Every Time.” 

The ICU staff’s diligence paid off, as the unit has not had a central-line bloodstream infection in over 15 months.

Staff from throughout the hospital have demonstrated their commitment to patient safety by using the central-line bundle (a list of tasks to prevent BSIs); all areas of the hospital (i.e., OR, PACU, Cardiac Cath Lab, Imaging, PICC Team) are using the proven guidelines when inserting central lines.

As the infection prevention team moves forward, they are focusing more on central-line maintenance issues and incorporating best practices, while continuing to refine the tools and processes that have been developed.

Recently, the team developed a monthly unit report for each area to remind staff how they are doing and to give pointers in areas that need improvement. The team’s new goal is to decrease all bloodstream infections to zero.

Durham Regional Hospital Reduces CLABSI

In December 2010, Durham Regional Hospital’s Critical Care Unit (CCU) unit celebrated 12 months with zero hospital-acquired CLABSI.

This success was due to the leadership of the bloodstream infection (BSI) team and staff nurses in the CCU. Together, these teams developed innovative ways to make sure everyone washes their hands appropriately and to ensure that central-line processes are as safe as possible.

Staff concentrated their efforts on compliance with evidence-based guidelines, including compliance with the Institute for Healthcare Improvement Central Line Bundle which includes:

• Hand hygiene
• Maximum barrier protection
• Chlorhexidine gluconate (CHG) skin antisepsis
• Optimal site selection
• Daily review of necessity

All CCU staff were educated about the less-obvious patient effects of CLABSI, including the extension of their hospital stay, changes in mortality rates, and costs. Education was consistently reinforced in addition to daily departmental huddle discussions and staff meetings that emphasized CLABSI as preventable hospital-acquired infections.

Staff were also empowered to hold all medical staff, including physicians, accountable for following bundles.

The team updated line carts and checklists, and introduced new supplies, including alcohol swabs with CHG and dressings utilizing a CHG-impregnated sponge. The executive leadership team supported these initiatives during safety rounds to the unit.

To generate enthusiasm, the team hosted bundle education parties; created and displayed animated posters in the staff areas; and wrote and introduced a 15-second song to sing while “scrubbing the hub." (The “hub” refers to the spot where the nurse connects IV tubing for medications; it is the barrier between the environment and the patient’s bloodstream.)

The team also used similar measures to educate and encourage each other to use appropriate hand hygiene. As a result, hand hygiene compliance has improved significantly, contributing to a decrease in CLABSI.