Infection Control Today

AUG 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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26 ICT August 2018 www.infectioncontroltoday.com DATE ASSESSOR PATIENT MRN ROOM# DEVICE TYPE L OR R ANATOMICAL INDICATION (VASCULAR ACCESS) During those discussions aspects of all lines present are included to give the broadest approach for reviewing possible opportunities for improvement. We engage staff to critically review the "why" behind the device choices and also include insertion staff and other involved departments to try to capture the fullest understanding. Infection preventionists, and many of us with specialized training, function within the broader function of hospital epidemiology – looking at the distribution and determinants of disease (in our case complication) within our patient population. When it comes to understanding the risks of all of our devices, we look beyond just those that develop an infection, knowing that preventing precursors to infection (poor site selection, non-intact dressings, occluded catheters, etc.) can help impact the incidence. Collaborating with our vascular access team, we have also created sustainable methods for capturing non-infectious complications from these devices as well to help with more fully understanding device risk. We work together to review (and compare across device types) issues such as completion of therapy, percent of patients discharged with lines in place, infltration, occlusion, phlebitis and other potentially preventable complications. While our organizations are required to report outcomes measures (i.e., CLABSI, MRSA Lab-ID, and C. diff Lab-ID), it would behoove us to spend considerable efforts monitoring process measures in an effort to correct defciencies before they lead to an infection, rather than waiting to conduct a huddle only after signifcant patient harm has occurred. Within our organization, we achieve this (with the support and guidance of the executive team) through multi-disciplinary process measures rounding. Rather than falling as a siloed activity for the infection prevention team (which is where its origins were within our facility), every inpatient unit is expected to round and document their fndings within a shared spread sheet. A screen shot of one of the data entry sheets is shown above and to the right. A data dictionary is provided to staff in an effort to ensure consistency in how measures are evaluated. Last year the organization opted to add some of the process measures to the unit score card, in addition to standardized device utilization ratios and standardized infection ratios. Each unit can access the elements of performance on their own patients, plus the aggregate data is presented monthly to Infection Control Committee. Taking it even a step further, every month, the infection prevention team coordinates inclusive rounding when vendors (representatives, clinical specialists, engineers, leadership, etc.) are welcomed and round with the hospitals' infection prevention team at the bedside to see how products are performing. The team is frequently joined by professional development and nursing leadership as well as members of the vascular access team. It provides front line staff with a chance to pose their questions to internal and external experts on every component of their care of central as well as peripheral lines and helps build collaboration on amongst providers of our bundle elements. There is much remaining work to be done to feel as that we have done everything possible to make vascular access as safe as possible for all patients. Consideration of expanding infection surveillance as well as process measure analysis across all devices can help identify opportunities for further study. Partnering with our vascular access teams individually at our organization, but also through active involvement with local and national organizations such as the Association for Vascular Access (AVA) can help us go even further in creating a complication-free possibility for our patients. Collaborating with our vascular access team , we have also created sustainable methods for capturing non-infectious complications from these devices as well to help with more fully understanding device risk. Ò VAD DEVICE TYPE TYPE # OF DEVICES % OF TOTAL PIV 0 #DIV/0! MIDLINE 0 #DIV/0! PICC 0 #DIV/0! PAC 0 #DIV/0! NONTUNNELLED CVC 0 #DIV/0! TUNNELLED CVC 0 #DIV/0! DIALYSIS CATHETER 0 #DIV/0! SWAN/CORIDS 0 #DIV/0! TOTAL 0 INDICATION INDICATION # OF DEVICES % OF TOTAL IVF 0 0% ANTIBIOTICS 0 0% PRESSORS 0 0% MEDS REQUIRING 0 0% CENTRAL ACCESS 0 0% MULTIPLE 0 0% INCOMPATIBLE MEDS 0 0%! DIFFICULT ACCESS 0 0% HEMODYNAMIC 0 0% MONITORING 0 0% OTHER 0 0% TOTAL 0

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