Champions for success cover bases with infection control bundles

Healthcare Purchasing News, June, 2008 by Jeannie Akridge

According to Dan Kidwell, network director of neuro sciences and pulmonary outcomes, Community Health Network, components of the vent bundle, developed in conjunction with VHA and the fill as part of the Idealized Design of the ICU collaborative, includes keeping the head of the bed elevated to 30[degrees], appropriate sedation, oral care, assessment for the ability to extubate the patient, DVT and PUD prophylaxis. Community Health Network also utilizes other innovative and costsaving measures throughout their system in what Kidwell calls their "recipe for prevention of VAP". With laser like focus, Kidwell and the Community team set out to eradicate VAP from their health system by looking at processes, protocols and equipment, challenging the status quo and implementing ground-breaking ideas along the way.

"I would tell every institution that reads this, that they need to follow the vent bundle because it is a good base," said Kidwell. "There's evidence to support it. I would also tell them that it's a very comprehensive view that they've got to take because it is now understood that VAP is avoidable. They've got to look at the culture of their organization, instill the belief that they can not only get to zero, but perhaps can eradicate VAP through the empowerment of staff and leaders to look at their environment and make change. By integrating education, cultural transformation, staff empowerment, and even instituting technology adaptation, those things can completely change how you work."

At Beth Israel Medical Center, compliance with bundle practices is enforced with kits that that contain the necessary components for safe central line insertions. Dr. Shulkin explained, "We make this easier for the clinicians by putting everything together into one centralized kit, which includes maximal barrier precautions plus an applicator and protective disk with chlorhexidine gluconate."

Sources related the importance of a checklist in ensuring consistency. "The primary thrust of any bundle is a 'checklist', borrowing from the airline industry," said McHugh. "If everybody does everything they're supposed to do there will be no errors."

Added Dr. Jarvis, "If that checklist is used at the time of catheter insertion, then if a bloodstream infection occurs, you can go back and look and see if those processes were all done correctly. And if they were, then perhaps it was a CRBSI that was inevitable."

McHugh emphasized the need for basic hygiene and aseptic technique in preventing CRBSIs. "While there's a lot of technology out there and there are a lot of good products--there are hundreds of good products--washing hands and using antisepsis when accessing a central line, that's the most important thing."

Dr. Jarvis discussed the need to 'scrub the hub' in order to maintain sterile technique. "Often times you see clinicians when they manipulate a catheter, they'll take the needleless connector at the end and then they'll swab it with alcohol for about one second and then disconnect it. Well, that's insufficient," he explained. "There was a study by Dr. Dennis Maki that showed that if you did that for literally five seconds to ten seconds, that almost 70 percent of them were still contaminated. So you need to have probably at least a 15 second scrub with either alcohol or chlorhexidine whenever you manipulate that needleless connector."