MedStar Health Blog

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.

Patient Jill Pinch saw the notice online: MedStar Washington Hospital Center was asking former hospital patients to volunteer to help them improve safety, communications and the overall hospital experience.  Jill had something to say. 

On November 29, 2013, the 35-year-old arrived at the Hospital Center after struggling for hours at a D.C. birthing center. Jill and her husband had planned natural childbirth, but in the end, Jill needed a C-section to bring her first-born, William, into the world.  And he needed a week-long stay in the hospital’s Neonatal Intensive Care Unit (NICU) to fight an infection.

“I was defeated, desperately trying to reconcile myself to this new reality,” Jill says. “But I had no frame of reference to help me understand what to expect. I didn’t even know what questions to ask.”

With that as background, Jill became one of the first members of the Hospital Center’s new NICU Patient and Family Advisory Council for Quality and Safety (PFACQS, pronounced P-fax) in 2015. Together, former hospital patients, family members and hospital staff discuss the patients' personal stories, their experiences and new ideas to help the staff see the hospital through the patients' eyes. The goal is to improve overall hospital patient safety, quality and, ultimately, the experience by keeping the Hospital Center’s mission—putting patients first— front and center.  

Building on Success

“The clinical care William and I received was exceptional,” Jill says. “But some communications could have been improved. Through the council, we’ve been looking at ways for the hospital to better share information about what’s happening, what to expect, what on-site resources are available to help patients and families adapt to their situation." 

Since this PFACQS was launched, the Hospital Center has created groups for hospital patients in the heart program, intensive care units and cancer.

Former hospital patient Alex Matthews joined the cancer PFACQS.

“I spent three weeks in the Hospital Center after having major surgery for pancreatic cancer in 2013,” he says. “My care was phenomenal. The nurses, in particular, were so caring and attentive. When I saw the hospital was looking for volunteers to help make it even better, I felt like I owed it to them.” 

Like Jill, Alex thought some of the non-medical aspects of his hospital stay could have been smoother.  He has ideas about wait times from admission to surgery and the timing of certain instructions delivered on the unit. Hospital staff on the cancer PFACQS listened. Now, they’re trying to streamline the admitting process and address other concerns voiced by Alex and fellow patient advocates.  

“Based upon what I’ve seen, the Hospital Center is committed to listening to the patient’s voice, and using our points of view to deliver the safest, evidence-based and compassionate care to every one of its patients,” Jill says. “Together, we’re making changes for the benefit of all.”

For more information on the Hospital Center’s PFACQS Program, click here.