Purpose

Improvement Tools/Methods
Limitations / Lessons Learned
Results
Process Improvement
Preventing CLABSI S.A.V.E.S Lives!
Danielle Garcia, Shana Udell, Isa Marquez, Leyla Samur, Chayris Ronco, Ashley Frasier, Payton Beavers, Ryan Everest, Jillian Roe, Mallory Mettler
USF Nursing Preceptorship Students
Contribute to the efforts of Morton Plant Mease hospitals to decrease the rates of
Central Line Associated Blood Stream Infections (CLABSI)
By creating and implementing our Preventing CLABSI S.A.V.E.S. Lives sign, we hope
to decrease knowledge deficit in our nurses and increase the use of proper and
effective strategies at preventing CLABSI.

Description of the Problem
Health care-associated infections (HAI) are among the most common complications of
hospitalization. According to several studies published in the American Journal for
Infection Control, catheter related bloodstream infections (CLASBIs) are common
hospital acquired infections that directly correlate to increased rates of patient morbidity
and mortality, as well as an increased cost of hospitalization. It is estimated that 80,000
central venous catheter infections occur in intensive care units each year, resulting in a
25% mortality rate. Reducing the rate of CLASBIs has become a high priority for the
Morton Plant Hospital organization and the infection control unit. The organization has
taken numerous steps to educate their staff about the proper technique for caring for
central venous catheters. Although, it appears that there is a knowledge deficit in
central line care for the majority of the staff nurses. In order to understand the areas of
deficit, our team prepared surveys to be distributed to various units at Morton Plant
Mease and Countryside Mease Hospital, to develop an appropriate intervention based
on the highest areas of deficit.
USF Central Line Care Survey Results: 44 Nurses Surveyed
86% of the nurses knew how often to change the central line dressing
73% of the nurses didnt know how long to cleanse the skin with the chlorhexidine swab
27% of the nurses said they rarely check the BayCare intranet regarding current
policies and updates
40% of the nurses reported that they felt extremely confident about caring for a central
line
Just 2 out of 44 nurses surveyed knew how long the sage wipes should be left in the
warmer
Why is Preventing CLASBIs a Top Priority for the Mease Hospital Organization
The issue of catheter related bloodstream infections is important because it directly
correlates to increased rates of patient morbidity, mortality, and increased costs of
hospitalization. In addition, these infections are preventable and with proper knowledge
and technique for central line care, the rate of CLASBIs can be reduced significantly.
Four separate evidenced based research studies published in the American Journal for
Infection Control have shown that a standard, hospital-wide infection control protocol for
central line care can reduce the rate of CLASBIs and can ultimately save patient lives.
As a group, we plan to reduce CLABSI by providing Morton Plant Hospital a poster
which describes key steps in preventing infections. We found that most nurses on
the various units did not know much information about CLABSI off hand. This poster
will ensure that specific benchmarks that will prevent CLABSI will take place as long
as the nurse is in the accurate mindset. Although the subject matter will be broad, it
address exactly what the nurses needs to do.
We used a surveillance and feedback system to create this poster through surveys
from our units.
The largest barrier we predict to encounter during this project is time. It will take
time for the hospital to fully implement our CLABSI prevention sign throughout the
entire facility. More importantly, many months will be needed in order to gather
reliable results on the effectiveness of our project.
We also expect participation to be a major barrier. The CLABSI prevention sign
could possibly be placed in hidden areas or not posted at all within patients rooms.
Also, nurses may not take the time to read or acknowledge the sign, defeating the
entire purpose of the project.
Morton Plant Mease Clinical Group
Improvement tools/Methods
Plan: Our MPM clinical group was contacted by Michele Haynes of Infection Control to
do a QI project on CLABSI maintenance/prevention at Morton Plant Hospital and
Mease Countryside Hospital.
Do: Our team created surveys with questions that asked How often is a central line
dressing change required? How long do you cleanse the skin with a Chlorhexidine
swab? What is the proper technique for cleansing with the Chlorhexidine swab?
What is your method of flushing?
Study: We have discovered that many nurses have a knowledge deficit when it comes
to the maintenance of central lines. Many of them either have no clue or are not sure of
the proper ways to cleanse the skin with Chlorhexidine or how long to cleanse it for.
Act: We have decided to create a sign that will be placed above the patients beds
(those who have central lines) with a step by step reminder of how to maintain central
lines. This sign will be a bright lime green with the acronym S.A.V.E.S.:
Sterility: Masks (2), gowns, gloves
At least 30 seconds: cleansing the skin with Chlorhexidine
Vigorous scrubbing: technique back and forth friction motion
Effective placement of disk: fully in contact with the skin (360 degrees around)
Seven days: change dressing every 7 days.
References
Gonzales, M., Rocher, I., Fortin, ., Fontela, P., Kaouache, M., Tremblay, C., & ... Quach, C. (2013). A
survey of Preventive Measures Used and their Impact on Central Line-Associated
Bloodstream Infections (CLABSI) in Intensive Care Units (SPINBACC). BMC Infectious
Diseases, 13(1), 1-14. doi:10.1186/1471-2334-13-562
Jeong, I., Park, S., Lee, J., Song, J., & Lee, S. (2013). Effect of central line bundle on central line-
associated bloodstream infections in intensive care units. American Journal Of Infection
Control, 41(8), 710- 716. doi:10.1016/j.ajic.2012.10.010
Klintworth, G., Stafford, J., O'Connor, M., Leong, T., Hamley, L., Watson, K., & ... Worth, L. J. (2014).
Beyond the intensive care unit bundle: Implementation of a successful hospital-wide initiative
to reduce central lineassociated bloodstream infections. American Journal Of Infection
Control, 42(6), 685-687. doi:10.1016/j.ajic.2014.02.026
Rattray, J. & Jones, M.C. (2007) Issues in clinical nursing: Essential elements of questionnaire design
and development. Journal of Clinical Nursing, 16, 234-243. Retrieved from
http://www.brighamandwomens.org/medical_professionals/career/cfdd/mentoring%20resourc
es/surveydesign.pdf
Thom, K. A., Li, S., Custer, M., Preas, M., Rew, C. D., Cafeo, C., &, M. E. (2014). Successful
implementation of a unit-based quality nurse to reduce central line-associated bloodstream
infections. American Journal Of Infection Control, 42(2), 139-143.
doi:10.1016/j.ajic.2013.08.006
Whited, A., & Lowe, J. M. (2013). Central Line-Associated Bloodstream Infection: Not Just an Intensive
Care Unit Problem. Clinical Journal Of Oncology Nursing, 17(1), 21-24.


Background
In 2013, the rate of CLABSI at Morton Plant Mease was 0.394 per 1,000 discharges
compared to the 0.57 per 1,000 discharges overall in the state of Florida.

Results are pending:
Our team is currently analyzing and re-assessing the second questionnaire to
evaluate the effectiveness of the S.A.V.E.S. impact on prevention of CLABSI in the
Morton Plant Mease Hospital.

Our team hopes to decrease the rate of CLABSI at Morton Plant Mease in half with
the use of S.A.V.E.S in the workplace. We foresee that with proper use of the
S.A.V.E.S model, nurses will become superior caregivers to patients with central
lines.


Team Members
MPM Infection Control
MPM IV Team
Units Involved:
Mease Countryside: Shaffer 4 North (Oncology), NICU, Level 3 (Telemetry),
Shaffer 3 (Telemetry), Shaffer 3 East (Telemetry).
Morton Plant Clearwater: NICU, Witt 3 (Telemetry), Emergency Department.
Measures
Our team has utilized a strategically developed questionnaire to measure and record
data in regards to the knowledge base and comfort level of nurses that perform
central line dressing changes/maintenance. Before implementation of the S.A.V.E.S.
display post, a questionnaire was administered to registered nurses on various units
(listed above). The results revealed a knowledge deficit across the board. Our team
used a synergistic co+mpilation of both the test-retest and alternate form reliability
survey method to develop a second questionnaire for the same group of individuals
to participate in after implementation of the QI intervention.
The development of the questionnaire was based off of the principles of reliability
and validity. According to an article in the Journal of Clinical Nursing reliability in
regards to a successful questionnaire refers to the repeatability, stability and
internal consistency of a questionnaire, while validity refers to whether a
questionnaire is measuring what it purports to and representing the conceptual
structure (Rattray & Jones, 2005). The surveys feature both simple yet thought
provoking open- ended and rating scale questions. The purpose of our study is
addressed in a brief introduction and was administered with the acknowledgment that
other than identification of unit in the hospital, the questionnaires were anonymous.
The second questionnaire administered includes questions relevant to the
intervention while still maintaining the conceptual integrity of the first questionnaire.
.