BEST PRACTICES
April 15

How applying human factors can improve your CLABSI prevention plan

In most cases, people choose to become clinicians out of a deep commitment to patient care. But clinicians—like everyone—are human beings. They can become tired, overworked and overwhelmed by the everyday demands of caring for multiple patients. The fact is, in a busy facility with limited staff, lapses in practice can happen, impacting patient care and safety.

This isn’t just a theory. In healthcare settings, human failure can cause up to 90 percent of such errors,1 including the kind that can lead to central line-associated bloodstream infections (CLABSIs) and other catheter-associated bloodstream infections (CABSIs). Medline’s BSI 2019 Discovery Assessment Findings reported that more than half of observed clinicians didn’t maintain aseptic technique every time they change a catheter dressing. Sixty percent didn’t always prepare a clean area for the dressing change kit.2

60%

of observed clinicians didn’t always prepare a clean area for a dressing change kit

But there is a way to achieve better compliance at your facility and help reduce CLABSI and CABSI risks. “The first step is observing the day-to-day experience of your clinicians. And then, using the learnings to design solutions that directly address those challenges,” explains Kristin Jacobs, Medline’s Clinical Resource Manager for Critical Care.

Sometimes referred to as ergonomics, human factors analysis can lead to practical changes across your system, making it easier for frontline staff to keep patients safe. On the other hand, if you ignore human factors, “you could increase the chance for more error,” Jacobs says.

So how can ergonomics help improve patient care and safety? Here are three human factors strategies designed to help your team prevent CLABSIs and other CABSIs.

|  Standardize product supply and procedure steps

Not having readily available supplies or having too many supplies on hand can lead to errors. When clinicians have to pull each item separately for a procedure, it can be all too easy for them to miss components or steps. When they have too many product options to choose from, it can cause confusion about what to use. Both situations “create opportunities for variability which can impact errors,” says Donna Matocha, Medline’s Manager for Clinical Resources, Critical Care.

Donna Matocha

“The human factors-based solution is to use all-encompassing insertion and maintenance bundles. These can help you make sure that every clinician can easily perform a consistent procedure using standardized products.”

Donna Matocha, Medline Manager for Clinical Resources, Critical Care

“The human factors-based solution is to use all-encompassing insertion and maintenance bundles. These can help you make sure that every clinician can easily perform a consistent procedure using standardized products,” Matocha explains. Including a simple checklist that summarizes every step that clinicians should follow can also help reduce variation.

“That’s human factors design. It’s everything clinicians need in one kit, and then you tell them what to do with it,” Jacobs adds.

Products to consider:

The CVC Insertion Bundle is designed to minimize practice variation and enhance clinical workflow. It addresses each step in the insertion process and specific objectives to safeguard against infection. All the necessary supplies are included and sequenced to anticipate the needs of the inserter.

From removal to application the Dressing Change System guides nurses step-by-step through sterile dressing changes. It contains all the needed supplies in order of use, with visual cues to ensure proper aseptic technique is consistently followed.

|  Empower your team with education and training

Too often, clinicians don’t have the time or the opportunity to receive training. And if they do get training, it’s usually for only a few minutes during rounds. That’s a problem, says Vincent Tessitore, Medline Clinical Resource Manager, Critical Care.

29%

of recently observed clinicians didn’t properly apply a chlorhexidine gluconate (CHG) dressing to disinfect the insertion site

Consider this: Our findings revealed that a quarter of recently observed clinicians didn’t use a securement device when inserting a catheter.2 Twenty-nine percent didn’t properly apply a chlorhexidine gluconate (CHG) dressing to disinfect the insertion site.2 In-person training and practical demonstrations of dressing change and line access protocols can help drive compliance in these areas. “But putting clinicians in the position of having to learn from a quick presentation at the nurse’s station when they have conflicting priorities isn’t effective,” Tessitore says.

He recommends 30-minute training sessions that take place away from the bedside. Education materials such as poster and easily accessible online courses and learning modules can also support education goals. But clinicians need to be able to review them on a schedule that’s easy for them to balance with patient care. That way “the end-user, the patient, is getting the best benefits,” Tessitore says.

Products to consider:

SorbaView Shield is a one-step securement system that withstands multi-directional tugging forces to hold the catheter in place. A film barrier protects the insertion site from contamination.

Aegis is a hydrophilic foam disc impregnated with chlorhexidine gluconate (CHG) that supports clinical best practices for CLABSI and CRBSI prevention.3,4,5,6 It absorbs exudate and inhibits or kills microorganisms on the dressing’s surface.

|  Create a collaborative, team-based culture

Inconsistency in various prevention practices across different units can be a major reason for higher CLABSI rates. For example, our analysis showed that in observed dressing changes, 44% of nurses didn’t perform hand hygiene appropriately.2

44%

of nurses didn’t perform hand hygiene appropriately

A unit-based champion strategy can help you reduce practice variation across all units. Clinicians with strong knowledge of prevention guidelines can serve as leaders in their units, helping motivate their colleagues with demonstrations and visual aids. For example, by posting hand hygiene reminder signs in patient rooms within their unit.

Evidence shows that it works. Through the On the CUSP: Stop BSI project, unit champions in different hospitals were designated to empower colleagues to follow CLABSI prevention best practices. States that participated in the project reduced CLABSI rates in their ICUs by 41%.7

“When you can get clinicians engaged, you’re creating shared responsibility for reducing infections.”

Vincent Tessitore, Medline Clinical Resource Manager, Critical Care

This strategy has proven to be essential for achieving positive prevention outcomes because “when you can get clinicians engaged, you’re creating shared responsibility for reducing infections,” Tessitore says.

Key takeaway

You can be more successful at reducing CLABSI rates if you incorporate solutions based on human factors in your prevention plan. Human factors or ergonomics focuses on identifying ways to prevent human error. When you observe clinicians caring for patients, you can see how too many supplies, inconsistent training, and differing levels of clinical expertise and experience can lead to practice variation. Addressing these issues head-on with intuitively designed products, comprehensive education and a collaborative strategy can help you drive a culture of safety across your organization.

Looking for more ways to help your clinicians keep patients safe from CABSIs?

Discover the 10 most common gaps in catheter care according to 3,900 clinician surveys.

Sign up for a BSI Discovery Assessment to identify gaps in care at your facility and receive a customized action plan to help improve infection rates.

Create a culture of prevention with Medline’s Vascular Access Management Solution.

Learn more about variations in catheter care that can lead to infection and how to prevent them.

References:

1. Human Factors Analysis in Patient Safety Systems. The Joint Commission The Source. April, 2015;13(4). Available at https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/assetmanager/humanfactorsthe_sourcepdf.pdf?db=web&hash=085A09275C38FACB50BC3D92CB35450A, Accessed February 9, 2021.

2. BSI 2019 Discovery Assessment Findings. Available at https://www.medline.com/media/catalog/Docs/MKT/WP/OTH-EBSI-Discovery-Assessment-Overview-11-20.pdf, Accessed on February 5, 2021.

3. Association for Professionals in Infection Control and Epidemiology. Guide to Preventing Central Line-Associated Bloodstream Infections. Washington, DC; APIC Implementation Guides, December 2015. Available at: http://apic.org/Professional-Practice/Implementation-guides/#implementaion-guide-7464, Accessed March 4, 2021.

4. The Joint Commission. Preventing Central Line-Associated Bloodstream Infections: A Global Perspective. Oak Brook, IL: Joint Commission Resources, May 2012. Available at: https://www.jointcommission.org/assets/1/18/CLABSI_Monograph.pdf, Accessed March 4, 2021.

5. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. O’Grady NP, Alexander M, Burns LA, et al. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/infectioncontrol/pdf/guidelines/bsi-guidelines-H.pdf, Accessed March 4, 2021.

6. Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O’Grady NP, Pettis AM, Rupp ME, Sandora T, Maragakis LL, Yokoe DS. Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology, Vol. 35, No. 7 (July 2014), pp. 753-771. Available at http://www.jstor.org/stable/10.1086/676533. Accessed March 04, 2021.

7. Eliminating CLABSI, A National Patient Safety Imperative Final Report on the National On the CUSP: Stop BSI Project, Available at https://www.ahrq.gov/sites/default/files/publications/files/clabsifinal.pdf, Accessed March 4, 2021.

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