Utilizing CSI to Reduce Central Line Infections - Meet the CLABSI Rangers

Critical care nurses are all too familiar with central line-associated bloodstream infections (CLABSI). Being extremely ill in the ICU instantly makes you more vulnerable to these infections. How to reduce the number of CLABSIs? Recently, Mary Watts, BSN, RN, allnurses.com Content and Community Manager interviewed a team of "CLABSI Rangers" from Swedish Medical Center, Seattle, Washington. They utilized a Clinical Scene Investigator (CSI) approach to reducing CLABSI rates in their ICU. The principal investigators were:

Heidi Mosher, MSN, RN, CCRN

Edward LeSage, BSN, RN, CCRN

Alisa Bowman, ADN, RN, CCRN

How to Choose an Issue for CSI?

Mary asked why they chose to investigate CLABSI. Heidi Mosher answered,” We had a high incidence for the past two years and we wanted to look at this to see if we could impact change.” This is the fundamental purpose of CSI - to identify a problem and then to work towards solving it. Edward LeSage agreed and added, "I got involved as a response to a need to reduce central line infections in our ICU.”

Applying CSI Principles to the Issue?

Mary then asked how they applied the teaching and tools of CSI Academy in executing their project? They all agreed that CSI provided a framework to put together a team and introduce a subject important to them and ways to tackle that. Their discussion:

Quote

"We started with a team of 5 nurses and first looked at data and the increase in CLABSI. We utilized the model of the previous CSI project (CAUTI reduction) to set smart goals after first analyzing the data related to our CLABSI rates. Then we were able to drill down the data to determine what the reasons for the infections are...what education was lacking. We utilized CSI forms to determine our smart goals. Our ultimate goal was to reduce CLABSI rates by 50% and in fact, were able to reduce CLABSI by 80%. We also needed champions and buy-in from our team. We set the goal of recruiting champions to 10, but we actually recruited 13. Our manager also saw the need for this project and we actually accomplished our goal in 12 months versus the expected 16 months."

Project Branding

Branding is always important too. The team had T-shirts designed along a forest park ranger theme with a tree of life and roots which were central line hubs. Branding the project was so important. "Since we are in the Pacific Northwest, we went with a park ranger theme,” Mosher stated. They also utilized an acronym:

• Clean hands and gloves
• Line care every 8 hours
• Assess daily need
• Bathe with chlorhexidine
• Scrub the hub
• Inclusive education

They wanted to generate conversation and even the patients and families got involved. This held the nursing staff accountable and responsible for the project. Educational fact sheets were also provided to families and signs were placed by the bedside so that families were aware of what needed to be done every time a central line was accessed.

Bedside nurses can make a difference and greatly impact patient care as these nurses have done...here is the entire interview.