Preventing CLABSI in Home Care

Collaboration produced a new home care toolkit for nurses

Peripherally inserted central catheters (PICC) and other central lines are essential for patients receiving intravenous (IV) fluids, blood products, medications, parenteral nutrition or chemotherapy on a regular basis. These lines, inserted into one of the patient’s major veins near the neck, gives healthcare providers an easy access point for distribution, creating a less invasive avenue for multiple needles and infusions.

Easy, however, doesn’t always mean clean. Central line-associated bloodstream infections (CLABSIs) occur when bacteria find their way into the bloodstream through the central line. An estimated 41,000 central line patients in the home care system contract a CLABSI each year, according to Audrey Adams, RN, MPH, CIC, director of infection prevention and control at Montefiore Health System in Bronx, N.Y.

Adams has spent 45 years working in infection prevention and control. “CLABSIs are significant infections that are preventable,” she said.

United Hospital Fund granted $100,000 to Montefiore and Northwell Health in a collaborative effort to reduce the risk of CLABSIs and find a standard of care. Adams was part of the team of researchers who developed the Preventing CLABSI in the Home Care Setting toolkit.

“CLABSI prevention efforts are well established in the hospital setting,” said Adams. “We wanted to evaluate these efforts in the home care setting and provide guidance where necessary.”

“There may be no follow through for why patients [from home care are] readmitted to the hospital due to lack of communication between the two entities,” added Donna Armellino, RN, DNP, CIC, vice president of infection prevention at Northwell Health and fellow researcher.

PICC Diagram 2Goals and Details
The goal of the toolkit is to reduce the rate of CLABSIs within the home setting, while keeping an open dialogue between hospitals and home care providers when need arises. It acts like a guide for institutions, home healthcare professionals and the patients living at home with central lines. From key terms to methods of keeping track of line types, the toolkit has information on the important elements of maintaining a central line.

“There’s the option to pick and choose what to use from the toolkit in a home care program,” Adams explained. The Preventing CLABSI toolkit is available online, where hospitals and home care providers can read through the data and decide which tools are best for their institution.

For example, the toolkit provides a monthly review sheet. Providers have the opportunity to track and monitor what kinds of lines their institution has in the home setting and which ones are becoming infected most frequently. From this, the hospital can detect the reasons for infection and prevent further CLABSIs from occurring. Armellino said, “It’s designed to give a calculation, which gives [the home care agency] a number and rate to compare infections from month to month.”

A communication guideline is included in the toolkit to better organize a patient’s CLABSI history. An example, Adams explained, would be a patient receiving home care who contracted a central line infection while in the home setting. The patient would have since recovered from the initial infection but still needs to be admitted to the hospital for other complications. The toolkit enables the hospital and the home care providers to have an open dialogue about the previous illness and how it was treated. The hospital can review the admitted patient’s central line history and determine the best course of action. “It’s another way to collaborate and communicate,” Adams said.

Likewise, the toolkit provides elements for the patients at home. “They can use the surveys to identify the patient’s understanding of their central line,” explained Armellino. “From there, the providers enhance the modification of education for the patients.”

Armellino added that an addendum to the toolkit should be available soon. It will include education about the basic principles of CLABSI prevention specifically written for patients. Questions, like “can I take a shower with my central line,” will be answered by this addendum, with detailed answers and means of care a patient can do on his or her own. Like the toolkit, the addendum will be available electronically.

Feedback and ResultsPICC Diagram 3
The toolkit has been implemented in the Montefiore Health System and Northwell Health for its pilot run. Armellino said feedback is positive. Participants report finding the toolkit helpful, enabling them to see central line infection rates, complication rates and hospital admission rates, she explained. “It’s helped the staff understand their care practices can have a negative or positive impact on the patient.”

Armellino, who has spent more than 35 years in healthcare, noted that infection prevention didn’t always receive this kind of attention. “I worked in the acute setting for many years, like the early ’90s, when [infection prevention] didn’t get as much attention.”

Today, it’s a different story:  While hospitals have worked to reduce such infections in the acute care setting, resulting in a 50% decrease nationally of catheter infections between 2008 and 2014 (according to CDC data), home healthcare providers didn’t have a clear maintenance standard. This toolkit provides a practical approach for implementing prevention measures to decrease the risk for central line infection and promote patient safety.

“Small, home care providers don’t always have hospital support,” Adams added. She hopes that through this toolkit, home care nurses can have the sufficient information necessary to carry out their duties. “The idea is to do what we can to spread this information,” said Adams.

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