When an infection control nurse at White Plains (N.Y.) Hospital realized central line-associated bloodstream infection rates for patients with peripherally inserted central catheters were on the rise, Saungi McCalla, RN, MSN, MPH, CIC, set out to bring those numbers down.
“We started looking at evidence,” McCalla said.
White Plains had 13 PICC-associated bloodstream infections in 2010, a rate of 1.9 per 1,000 line days, above the desired level. McCalla considered antimicrobial-coated PICCs, but those were not compatible with other equipment being used. After talking with nursing staff, McCalla learned variances existed in how nurses scrubbed the line hubs, which should be performed for 45 seconds every time the line is accessed.
“One of the main things we were facing is that people did not have time to scrub the hub or didn’t have alcohol wipes in their pocket,” said McCalla, director of infection control at the hospital. “We needed to come up with a solution to get them to comply.”
McCalla attended an Association for Professionals in Infection Control and Epidemiology conference, learned about disinfection caps and brought back samples. She convened a multidisciplinary team to investigate.
“We looked at all of them based on comfort of the patient, visibility and risk of cross contamination,” McCalla said. “We also showed them to a few nurses to see what they preferred.”
The nurses liked the SwabCap. All they had to do was place the device, an orange plastic cap with a medical-grade sponge saturated with 70% isopropyl alcohol, on the hub. When the cap is twisted onto the hub/IV connector threads, the sponge is depressed and releases alcohol onto the hub, disinfecting it while staying in place until the next time the nurse needs to access the line.
Every access site on the tubing receives a cap. Once a medication is given through the line, the nurse flushes with a prefilled saline syringe and a clean cap, all packaged together in a kit.
The team obtained approvals to try SwabCap disinfection devices on two units, where the change was well received.
In 2011, the hospital’s Infection Control and Product Evaluation committees gave the approval for implementation and required an analysis of post-intervention results. The hospital had 14 infections, a rate of 3.85 per 1,000 line days in the six months before implementation.
Staff development educator Meg Warren, RN-BC, MSN, CPAN, educated nurses about how to use the caps and the reason for the change and monitored compliance.
“It’s a pretty simple product but knowing the importance of why we are using it, we have had good results,” Warren said. “This does work. We are an institution that has great results.”
During the first six months of using the caps, the number of infections fell by 70% to 4, a rate of 1.14 per 1,000 line days. Then from October 2012 through March 2013, no CLABSIs occurred. The hospital avoided 10 bloodstream infections in those six months for a savings of $291,660.
The hospital experienced one infection in April and two in May. Each infection was reviewed by the all-nurse PICC team. The review showed a break in technique during dressing changes and staff was re-educated. By June, the number of infections fell again to zero.
“The caps are saving us from infections on the central lines,” said Joyce Bogetti, RN, nurse manager of the PICC Team at White Plains.”This relatively simple intervention was a big success.”
McCalla credits teamwork and nursing input as valuable to the project’s success. She also has found constant monitoring improved compliance with the caps and has kept infections down.
White Plains Hospital has expanded the use of the caps to peripheral lines because of the effectiveness experienced with the PICCs.
“We wanted to make sure all patients received the same care and protection” McCalla said. “We were able to show a return on investment with the reduction in our CLABSI rate.”
Debra Anscombe Wood, RN, is a freelance writer.