Chlorhexidine – Rub the Hub before You Plug – Eliminating CRBSI in MICU/MSICU

Abstract

Problem

A dangerous complication that can occur from a central line is a catheter-related bloodstream infection (CRBSI). Most of our patients in the medical intensive care unit/medical surgical intensive care unit (MICU/MSICU) have central lines. Our CRBSI rate averaged 3.98 from January–July 2009. Centers for Disease Control’s (CDC’s) goal for CRBSIs is zero. CRBSIs will increase cost of care, length of stay, and places a patient at risk of increased morbidity and death.

Evidence

CRBSIs occur in 3–7% of ICU patients with central lines.¹ These infections can cost up to $56,000 per event.² CRBSIs occurring during hospitalization are no longer reimbursed by the Centers for Medicare and Medicaid.³ Mortality rate is 12–25% 2 which potentially could be avoided if the goal of zero events is achieved. Eliminating a CRBSI will cut healthcare costs and improve patient outcomes.

Strategy

MICU/MSICU replaced alcohol with 2% Chlorhexidine (CHG) to aseptically clean IV catheter hubs. CHG is classified as a chemical antiseptic and is effective in killing most bacteria including gram positive bacteria, MRSA, VRE, C. diff., various fungi, and viruses.⁴

Practice Change

MICU/MSICU staff was educated on the proper use of CHG to access IV catheter hubs in July 2009. Signage was also posted as visual aids: Rub the Hub before you Plug! Hospital policy was updated in December 2009.⁵

Evaluation

Infection preventionists run monthly reports to determine if positive blood cultures are a hospital-acquired CRBSI. MICU/MSICU results are reported to staff during monthly meetings.

Results

Our CRBSI rate decreased from 3.98 to 2.56 over the five month period after initiation of CHG usage to access IV catheter hubs. Zero events were recorded for November 2009–February 2010 in both units.

Recommendations

MICU/MSICU staff needs to continue diligent management of central line catheters. Regularly update staff with current CRBSI results.

Lessons Learned

Frontline nursing staff is making a huge impact utilizing evidenced-based practice to decrease healthcare costs and improve patient outcomes.

Bibliography

• ¹Abe, C., Zack, J., & Vanderveen, T. (2007, Nov. – Dec.). Zero Tolerance: Curbing Catheter-Related Blood Stream Infections. Patient Safety and Quality Healthcare, 3. Retrieved February 22, 2010, from http://www.psqh.com/novdec07/zerotolerance.html.
• ²FirstDoNoHarm.com — Catheter-related Bloodstream Infections. (n.d.). FirstDoNoHarm.com. Retrieved March 4, 2010, from http://firstdonoharm.com/
• ³Moureau, N. (2009). IV Rounds:Reducing the cost of catheter-related blood stream infections. Nursing 2009, 39(7), 14–15.
• ⁴Keeping Your Central or PICC Line Safe:Using Chlorhexidine Products to Prevent Infection. (2008, August). Complex Child E-Magazine, 1, #7. Retrieved March 4, 2010, from http://articles.complexchild.com/Aug2008/00060.html.
• ⁵Central Line Policy. (n.d.). http://mhmhweb01/policy/. Retrieved March 4, 2010, from mhscentral/default.aspx.