We need to have super-users on the floor in the ward , and have the vascular access team — if you have one at your institution — provide education and hands-on training , observing clinicians to make sure they know how to perform these clinical tasks up to the organizational standard . We must ensure that personnel learn how to do things the right way early on , so we ’ re not trying to chase bad habits that form inadvertently later .”
We need to look at whether we are putting in central lines that are no longer clinically indicated . Have we looked at updating our indications for lines compared to changes in medication administration , utilization of midline catheters , etc ., and then moving through what is happening at the point of insertion ; are we using checklists , are we ensuring that staff are trained appropriately , etc . You must walk through the process slowly to isolate where the gaps might be .”
Implementation of CLABSI prevention strategies might be as simple as integrating best practices to reduce the risk of infection and incorporating a culture to support implementation . But it ’ s easier said than done at many facilities . The Compendium suggests that hospitals should address technical and socio-adaptive components to CLABSI prevention , including formal training of healthcare personnel on indications , placement , and maintenance of devices , in addition to regular assessment of competencies .
The Compendium authors point to a widely used model in the U . S . known as the “ Four Es ” ( engage , educate , execute , and evaluate ), which entails summarizing evidence , identifying local barriers to implementation , measuring performance , and ensuring that patients receive the infection prevention intervention by addressing knowledge , critical thinking , behavior and psychomotor skills , as well as attitudes and beliefs of all members of the healthcare team involved with the insertion and care of CVCs . Additionally , the Compendium authors recommend that facilities consider using tools to promote high-reliability processes ( Lean Six Sigma ) and to enhance teamwork ( Team STEPPS ).
Education and training are at the heart of successful CLABSI prevention , says Cawcutt .
“ When you look at implementation and dissemination sciences , education is always going to be a key component ,” she says . “ In the Compendium the authors address the importance of education and training . It ’ s also critical to understand that education is not durable , but there ’ s turnover , and personnel can forget to remove catheters as soon as possible , for example , if it ’ s not ingrained in the organizational memory . We have seen large numbers of personnel during the pandemic especially coming into the healthcare system who may not have had the same levels of education and training , especially when we ’ ve seen a massive workforce change with so many people leaving medicine . There are many brand-new graduates coming in and we must remember that they were trained in the middle of a pandemic and that training may be substantially different than the training people received pre-pandemic . I think that fact is easily forgotten , in that we think everyone should be the same way forever , but nobody was trained the same way during the pandemic . We must admit that we may have made assumptions about what personnel have been taught , and we now must walk them through the proper procedures . We need to have super-users on the floor in the ward , and have the vascular access team — if you have one at your institution — provide education and hands-on training , observing clinicians to make sure they know how to perform these clinical tasks up to the organizational standard . We must ensure that personnel learn how to do things the right way early on , so we ’ re not trying to chase bad habits that form inadvertently later .”
For many healthcare systems , the Compendium update represents an opportunity to revisit best practices , and post-COVID seems to be what many are considering “ the great reset ” in healthcare in general .
“ Preventing healthcare-associated infections is a national and global priority ,” says Sharon B . Wright , MD , MPH , FIDSA , FSHEA , president of the SHEA board of trustees . “ It ’ s a pivotal time . We must get back to basics , redouble efforts , and create systems of care that even in situations of great stress have what they need to keep patients safe from preventable HAIs .”
Cawcutt concurs . “ I will quote my esteemed boss and one of the authors of the Compendium , Dr . Mark Rupp , who will always remind everyone to never waste a good crisis . I think we can either move forward in fear , saying everything went off the rails and we have a great deal of work to do and dread the next pandemic . Or we can move forward with a spirit of curiosity and a perspective of learning to be better and look at what could we sustain , how do we keep that , and what do we fail to sustain and why . How do we re-engineer , rebuild , re-provide that care so that it is more durable going forward . There ’ s no opportunity like now than to step back , reflect and determine what we could have done to prevent anything that didn ’ t uphold expected patient outcomes . We must not be panicked about the things that we have found that happened during the pandemic , but we need to look at the gaps and think , if we could go back to the middle of that crisis , is there anything that we can envision , or innovate that could have made it better , and we need to take those steps .”
Cawcutt continues , “ I don ’ t think it ’ s going to be perfect ; I think we are all ready to see the various struggles based on all the different challenges that each healthcare organization has in this post-pandemic era and try to figure out where we go from here . I don ’ t think we ever go back to pre-pandemic practices ; we all need to look at how we envision things going forward as being more durable , more sustainable , and in a way that ensures our patients still receive phenomenal patient care and our workforce is not burning out from overload .”
References :
Buetti N , Marschall J , et al . Strategies to prevent central line-associated bloodstream infections in acute-care hospitals : 2022 Update . Infect Control Hosp Epidemiol . Vol . 43 , No . 5 . pp . 553-569 . May 2022 .
Fakih MG , Bufalino A , Sturm L , et al . Coronavirus disease 2019 ( COVID-19 ) pandemic , central-line-associated bloodstream infection ( CLABSI ), and catheter-associated urinary tract infection ( CAUTI ): the urgent need to refocus on hardwiring prevention efforts . Infect Control Hosp Epidemiol . 2021 ; 43 ( 1 ): 26-31 .
McMullen , KM , Smith , BA , Rebmann , T . Impact of SARS-CoV-2 on hospital-acquired infection rates in the United States : Predictions and early results . Am J Infect Control 2020 . 48:140911411 .
Weiner-Lastinger LM , et al . The impact of coronavirus disease 2019 ( COVID-19 ) on healthcare-associated infections in 2020 : A summary of data reported to the National Healthcare Safety Network . Infect Control Hosp Epidemiol 2022 ; 43:12-25 .