North Carolina Prevent Catheter-Associated Bloodstream Infections (CLABSI): Targeting Zero Tool Kit Supplement

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1 North Carolina Prevent Catheter-Associated Bloodstream Infections (CLABSI): Targeting Zero Tool Kit Supplement A Supplement to the National Stop BSI Campaign Toolkit Sponsored by Leadership Partners for the NC Prevent CLABSI Collaborative 1

2 MAY 2011 The materials in this tool kit can be reproduced for the purpose of improving processes in a hospital or healthcare organization, but cannot be reproduced with intentions of commercial use. Important Note: This tool kit is a supplement to the national Stop BSI tool kit on-line at It was prepared to support NC facilities as they move into the next phase of CLABSI prevention. The national toolkit will remain the principle tool kit and will be used to obtain important information and guidance, especially surrounding CUSP (Comprehensive Unit-based Safety Program) and the adaptive aspects of this collaborative. The national tool kit and this supplement should be used together for maximum benefit. Acknowledgements Thanks to those that have shared their time and expertise to help develop and produce this tool kit. It is through their expertise, creativity and generous sharing of knowledge, resources, and skills that it is made available. The following NC Center for Hospital Quality and Patient Safety staff members were involved in writing or editing this tool kit. Joanne Campione, PhD, MSPH Director, Clinical Measurement Services Latoshua LeGrant, AS, CQIA Project Manager Shelby Lassiter, RN, BSN, CPHQ, CIC Performance Improvement Specialist Laura Maynard, M.Div. Director, Collaborative Learning Carol Koeble, MD, MS, CPE Director Erica Preston-Roedder, PhD, MSPH Healthcare Analyst 2

3 The following individuals gave of their time and expertise to plan and/or write and/or review and/or edit designated chapters within this toolkit supplement. Pam Isaacs, RN, BSN, MHA, CIC Clinical Operations Director, Infection Control and Epidemiology Duke University Medical Center Polly Padgette, RN, BSN, CIC Infection Control/Employee Health Manager Duke Raleigh Hospital Sue Collier, RN, MSN Vice President, Patient/Family Experience University Health System Elaine Long, RN, BSN Strategic Services Associate Risk Management / Regulatory Affairs Duke Raleigh Hospital Wendy Perkins-Hicks, RN MSN Clinical Practice Manager Cardiac & Vascular Pre and Post Procedures Forsyth Cardiac & Vascular Center Forsyth Medical Center Tara Bristol, MA Family Support Specialist UNC Health Care, NC Children s Hospital The following individuals serve as a collaborative Leadership Partner and have devoted their time and expertise to the overall development and deployment of this collaborative. Jeana Partington BSN, RN, CPHQ Care Improvement Specialist The Carolinas Center for Medical Excellence Swati Bhardwaj Supervisor Operations Southern Atlantic Healthcare Alliance Karen Southard, RN, MHA Care Improvement Specialist The Carolinas Center for Medical Excellence Constance (Connie) D. Jones, RN, CIC Healthcare - Associated Infections Coordinator NC DHHS, Division of Public Health Communicable Disease Branch Carol Koeble, MD, MS, CPE Director, Joanne Campione, PhD, MSPH Director, Clinical Measurement Services Polly Padgette, RN, BSN, CIC APIC-NC Representative Infection Control/Employee Health Manager Duke Raleigh Hospital Laura Maynard, M.Div. Director, Collaborative Learning Latoshua LeGrant, AS,CQIA Project Manager Shelby Lassiter, RN, BSN, CPHQ, CIC Performance Improvement Specialist Zack Moore, MD, MPH Medical Epidemiologist HAI Prevention Program Medical Director North Carolina Division of Public Health Chrystal S. Adams, RN Care Improvement Specialist The Carolinas Center for Medical Excellence 3

4 The following individuals serve on the collaborative Expert Panel and have devoted time and expertise to the development of the collaborative. Tara Bristol, MA Family Support Specialist UNC Health Care, NC Children s Hospital Carol Koeble, MD, MS, CPE Director, Joanne Campione, PhD, MSPH Director, Clinical Measurement Services Sue Collier, RN, MSN Vice President, Patient/Family Experience University Health System David Colonna, MD Anesthesiologist Medical Staff President, Forsyth Medical Center Wendy Perkins-Hicks, RN, MSN Clinical Practice Manager, Cardiac and Vascular Pre/Post Procedure Unit Forsyth Cardiac and Vascular Center Forsyth Medical Center Pam Isaacs, RN, BSN, MHA, CIC Clinical Operations Director, Infection Control and Epidemiology Duke University Medical Center Robert J. Sherertz, M.D. Hospital Epidemiologist, Medical Director of Physician Quality Outcomes, and, Professor of Medicine-Infectious Disease Wake Forest University Baptist Medical Center Winston-Salem, NC Mandy Richards RN, MSN Project Director FutureCare of North Carolina, Inc. North Carolina Health Care Facilities Association Hedwig Mazzawi, RN ICU Staff Nurse Onslow Memorial Hospital Martin J. McCaffrey, MD Associate Professor, UNC School of Medicine and Director, Perinatal Quality Collaborative of NC Zack Moore, MD, MPH Medical Epidemiologist HAI Prevention Program Medical Director North Carolina Division of Public Health Keith Ramsey, MD Medical Director, Infection Prevention and Control, Pitt Memorial Hospital Professor of Medicine, Brody School of Medicine, East Carolina University James D. Whitehouse, MD Infectious Disease and Internal Medicine Asheville, NC William A. Rutala, Ph.D., M.P.H Professor, Division of Infectious Diseases, Department of Medicine, Director, Statewide Program for Infection Control and Epidemiology, University of North Carolina School of Medicine (Chapel Hill) Director, Hospital Epidemiology, Occupational Health, and Safety Program at UNC Health Care System Laura Maynard, M.Div. Director of Collaborative Learning 4

5 Special thanks also to: 1. Stephanie Strickland, Director of Communications at the NC Hospital Association, who generously donated her time to proofread and edit this tool kit, and, 2. WakeMed Health and Hospitals for use of the simulation laboratory in their Center for Innovative Learning. They allowed us to take pictures of simulated central line insertions, dressing changes, and patient/family/healthcare team interactions. WakeMed staffs specifically involved were: Amar P. Patel, MS, NREMT-P, CFC Director, Center for Innovative Learning Peggy Lassiter, RN, BSN Resource Specialist Resource Management Christine O Neill, RN Simulation Education Specialist Crystal Brantley, RN Pediatric Critical Care Transport Nurse Table of Contents Chapter 1: Introduction Chapter 2: The Pathogenesis and Microbiology of CLABSI Chapter 3: Prevention Strategies Chapter 4: Patient and Family-centered Care Chapter 5: Business Case for CLABSI Prevention Chapter 6: Importance of Hygiene for HAI Prevention Chapter 7: Measurement Chapter 8: References and Tools Forward It has become evident that in order to reduce patient harm and improve patient outcomes, healthcare providers must address the technical aspects of process improvement by developing reliable systems of care. These technical areas are where we can clearly define the problem and list potential solutions, while often requiring minimal learning. Healthcare providers must also address adaptive issues or the culture that exists in their organization. Adaptive components are things that deal with people's attitudes, beliefs 5

6 and behaviors. This is less easily defined and requires a shared responsibility for change: leaders share responsibility with organizational staff and key stakeholders. It is these elements, technical and adaptive, that are the foundational elements of the NC Center for Hospital Quality and Patient Safety (). The technical foundational element is represented by reliable process design. The adaptive elements are addressed through optimizing teamwork and communication among all healthcare providers and promoting a fair and just culture. The is driving hospitals to assess these foundational elements within their own four walls, to identify opportunities for improvement and to strengthen the hospital infrastructure, and to align with these goals. By addressing both of these aspects of change, technical and adaptive, your team can prepare the healthcare providers on the selected unit for the project to prevent bloodstream infections and to understand the science of safety, assisting them in making safe choices to sustain the gains. This tool kit supplement, in tandem with the national tool kit, will explore the technical challenges of preventing catheter-associated bloodstream infections (CLABSI). It will provide guidance on implementation, as well as tools that can be readily adapted and used in your organization to prevent these dangerous infections. Project management tools will assist teams to plan and track their implementation. Performance improvement methods and measurement will assist teams to design reliable processes. Evidencebased prevention strategies will assist the team with developing ideas and educating the healthcare team to prevent CLABSIs. 6

7 Figure 1: The Foundational Elements Organizational Learning Reliable Design Teamwork & Communication NC Hospitals Safest, Highest Quality in the US Organizational Learning Just Culture Organizational Learning Additionally, the national tool kit will explore organizational culture. It will discuss cultural measurement tools, explore optimal team functioning, provide strategies to improve communication, enhance transparency efforts to drive improvement, and promote establishment of a just and fair culture. The teams on the identified unit will work with culture concepts and tools to work on improving their culture. The national tool kit and this supplement were written to support healthcare improvement teams in their journey to deliver evidence-based, safe care for their patients. They are to be used as source documents for the NC Prevent Catheter- Associated Bloodstream Infections Collaborative. 7

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