Infection Prevention Manual

EXPOSURE CONTROL PLAN hospice organization with a percentage rate of compliance for disinfecting the catheter hub prior to accessing the central line. This data will be monitored over time and displayed on a run chart and analyzed against the targeted compliance rate set by our agency. (zero CLABSIs) Central Line Necessity Our Agency routinely evaluate the necessity of all CVCs and recommend the removal of nonessential catheters. Often central lines remain in place because of convenience for the patient by providing a reliable means of obtaining a blood sample or accessing the patient's venous system for scans and other tests in case it is needed. They also remain in place because healthcare personnel have previously not considered recommending them for removal. The longer the central line remains in place, the higher the risk of infection over time. Once the central line is removed, so is the risk of CLABSI. The CDC recommends that any intravascular catheter be promptly removed when it is no longer essential, recommend reviewing the medical necessity of the central line on a daily basis in an acute care setting to prevent any unnecessary delays in promptly removing a central line that is no longer clearly needed for the patient's care. Is it our policy that on admission, at the completion a course of home intravenous therapy if applicable, at the time of recertification and at the time of discharge the central line will be routinely evaluated and the criteria for when the nurse would make a recommendation for removal. During the evaluation, the nurse would assess whether the CVC would be considered nonessential and whether the criterion for removal was met. When a nonessential CVC is identified, the physician should be contacted and a recommendation made that the nonessential catheter be removed. The nurse may obtain orders for its removal in the home setting or arrangements may be made to have the central line removed in a healthcare facility. The physician may also determine that the CVC is still considered to be essential to meet the patient's care needs. Regardless of the outcome, the catheter evaluation and communication with the physician about the recommendation for removal of a nonessential CVC is to be documented in the clinical record. Performance Measures Our Agency chose to monitor our internal performance as to whether the need for a central line was being assessed according to our internal policy, data could be collected measuring the percentage of patients with a central line that had documentation of the central line necessity being evaluated. For example, the numerator would be the number of patients with a central line where there is documentation of an evaluation according to the time set in policy divided by the number of patients with a central line times 100. This formula would provide to our Agency with a percentage compliance rate that could be monitored over time and displayed on a run chart and analyzed against the targeted compliance rate set by the organization. Agency Challenges One of the challenges in providing care in the home setting and targeting a zero CLABSI rate is that home care staff are not the only ones providing direct, hands-on central line care. In between home visits, other caregivers manipulate and flush central lines and may even administer medication through the central line. Patients may also go to other care settings in between home visits, such as dialysis centers, physician's offices, and ambulatory infusion centers. This doesn't mean that zero CLABSIs is not attainable, it just means that assessing the patient and caregiver's knowledge and competence about implementing measures that can be taken to prevent CLABSIs is more important. If we effectively teach our patients and their caregiver's infection prevention and control measures they too can understand the importance of infection prevention while providing care and advocate for the patient in other care settings. Not only will our home care staff be focusing on preventing central line infections, but also staff in other facilities and organizations. It will be through this coordinated, concerted effort that there will be a reduction in the number of preventable central line infections. Preventing CLABSIs begins with the individuals inserting the central line and continues through to the nurse providing care in the home setting who will reinforce the education provided to the patient and their caregiver, assess the patient's knowledge and competence, and provide ongoing catheter care and maintenance activities as needed. Together we will all make a difference.