Central Line-Associated Bloodstream Infection (CLABSI) FREE

CLABSI Free - A Quality & Safety Milestone 

This week, Unit 2G, a medical intensive care unit at MedStar Washington Hospital Center, achieved a major milestone: reaching two years without a Central Line-Associated Bloodstream Infection (CLABSI).

Central lines (catheters) are tubes that help patients get the medications or fluids they need and allow medical professional to draw blood for testing.  But they also present a particular risk for developing infections, because they are inserted into large veins in the neck, chest or groin.  While these lines are necessary, they must be monitored continuously and carefully.  Medical professionals have been working hard to reduce CLABSI rates in hospitals, and from 2008 to 2013, there was a 46% decrease in CLABSI in hospitals across the U.S., according to the Centers for Disease Control and Prevention (CDC).  Yet, an estimated 30,100 CLABSI cases still occur in U.S. hospitals each year.

How did the physicians and nurses on 2G keep CLABSI at bay for two years (and counting)?  They credit dedicated teamwork for their success. "The most important step is collaboration and communication between all team members,” notes Joshua Wansley, RN, a nurse leader on the unit. “Twice a week, nurse leaders and attending physicians check on every patient and assess if the central lines are still needed for that patient.”

In fact, nurse leaders take the extra step of reviewing central line records every day to verify that the line is needed. “The goal, of course, is that you only have lines in that are absolutely necessary," says Wansley. "That one extra review could show a line ready to be removed.  If it comes out, the risk is gone.”

Resource nurses -- the nurses who manage the workflow on a shift -- keep careful records of patients' central lines. Nurses are tested every year on their skills for changing the dressings around the central lines and other protective steps needed to keep patients safe.  “We also talk about it all the time, so we are all very aware of the current situation with central lines. Our goal is to go that extra mile  to protect the patients," Wansley concluded.

And at the Hospital Center, every patient unit posts its current record in a highly visible place for all to see.  Much like a construction site that records the number of days since its last employee injury, our patient units post the number of days since the last CLABSI.  Keeping it top of mind among every team member -- and among patients and families -- will help 2G and every other unit at the Center prevent these life-threatening infections.   

For Patients:  What You Can Do to Help Prevent CLABSI

Patients can also play a role in preventing CLABSI. The CDC suggests:

  • Speak up about any concerns so that those providing your care are reminded to follow the best prevention practices.
  • Ask your healthcare provider if the central line is absolutely necessary. If so, ask them to help you understand the need for it and how long it will be in place.
  • Pay attention to the bandage and the area around it. If the bandage comes off or if the bandage or area around it is wet or dirty, tell a healthcare providerright away.
  • Don’t get the central line or the central line insertion site wet.
  • Tell a healthcare provider if the area around the catheter is sore or red or if the patient has a fever or chills.
  • Avoid touching the tubing and do not let any visitors touch the catheter or tubing as well.
  • MOST IMPORTANTLY:  The single most important thing that everyone can do is wash their hands.  Everyone who comes into the room to visit or care for a patient with a central line must wash their hands—before and after they visit.  If you are a patient, speak up if you see someone who doesn't follow this very important rule.  If you are a family member or visitor, be mindful of the rule, follow it, and speak up if others don't. It's simple -- and effective.

Getting Care Where I’m Most Comfortable—Medical House Call Program

The below entry by Arnold Goldberger, Washington, D.C., was originally published on the U.S. Department of Health & Human Services blog.

One day in October, my wife Avriel fell and suffered a stroke. Fortunately, a nurse practitioner from MedStar Washington Hospital Center’s Medical House Call Program quickly arrived at our home. Nurse Genet Taye evaluated Avriel’s condition and consulted with our doctor by phone. They determined that she didn’t need to go to the emergency room that evening, but could remain comfortable at home until the next morning.

Dr. George Taler, a co-founder of the Medical House Call program, helped me advocate for my wife throughout her hospitalization. He always had time to talk with my daughter and me. He never seemed to be in a rush.

As Medicare patients, my wife and I were able to join the Hospital Center’s Medical House Call program. This program is one of 14 sites of the Independence at Home Demonstration under the Affordable Care Act’s Innovation Center housed in the Centers for Medicare and Medicaid Services. The demonstration, which is the same model of care as the Medical House Call program, is designed to bring quality health care to frail seniors on Medicare in the comfort of their homes and avoid the more costly care in emergency rooms and hospitals. I am not enrolled in the Independence at Home Demonstration because I have not been hospitalized in the last year, which is a good thing, but that’s a criterion for the demonstration. Still the quality and type of primary care I am receiving at home is the same as for those Medical House Call patients who are enrolled and being studied in the demonstration.

We both got first class care through Medical House Call. But sadly after 65 years of marriage, Avriel passed away last year.

I’m still a patient in the program. I’m 89 and when I have a health problem or question, I don’t like being unable to reach a doctor. I don’t like going to the emergency room unless it’s absolutely necessary. And I’d prefer a doctor who knows geriatric medicine.

MedStar Washington Hospital Center has two House Call teams that include physicians, nurse practitioners and social workers. Drs. Taler and Eric De Jonge, who lead their teams, are geriatricians. I know I can reach the team on a 24/7 basis and get quality care.

Genet comes regularly once a month to check out my vitals, and to make sure I have the correct medications and in the right order. You’d think she doesn’t trust me! And I get a copy of her notes.

Dr. De Jonge, who’s also a co-founder of Medical House Call, comes at least once every three months. And I always insist they stay for lunch.

When my wife sprained her ankle, the nurse was there within the hour; Dr. De Jonge said she needed X-rays, so a technician came to our home within 20 minutes with a mobile, digital X-ray machine.

When my eyes started to tear up and turn red recently, Genet was with another patient but she arrived at my door in half an hour. She evaluated my condition and gave me a prescription for an ointment.

They kept my wife and me out of the ER numerous times. And if I have to go to the hospital, all of my records are there. No fuss, no muss. The teams have mobile, wireless access to my electronic health records, and that means the doctors can view accurate information and the teams are well-briefed on my situation. 

You can find out more about the Independence at Home Demonstration here. You can even learn how they’re reducing Medicare costs as well as meeting quality measures, like reducing hospital readmissions, admission rates for patients with serious chronic illnesses, and ER visits.

For me, the Medical House Call program is on my speed dial.

Have any questions?

We are here to help! Click here for more information about the program. Or call us at 202-877-3627.

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