"The numbers really do speak for themselves about the effectiveness of the programme. We’ve been able to move from having mechanical complications to having none, and we've been able to sustain that over time. We haven’t had a line insertion infection in I can’t remember how long. I’ve learned through this project that you can achieve zero."
Mara Bryant, Sr. Vice President, Organisational Excellence, White Memorial Medical Centre
Striving for Excellence
White Memorial Medical Centre, a member of the Adventist Health System and a 353-bed hospital in downtown Los Angeles, was concerned about its rates of iatrogenic pneumothoraces (IP) and central line-associated blood stream infections (CLABSI) and set out to improve the situation. According to Mara Bryant, White Memorial's Senior Vice President for Organisational Excellence, "We strove to reach that extra level of being able to deliver on really perfect care." The inner-city medical institution organised a taskforce to study the problem and find a solution that was "reliable and could be done safely 24 hours a day, seven days a week."
With this goal in mind, White Memorial Medical Centre implemented the Sonosite Central Line Management Training Programme, which ran from January 2010 through August 2011. Among the onsite programme's many instructional elements were: the teaching of a six-point bundle to address both mechanical and bloodstream complications; hospital-wide training related to best practises for central line placements; “train the trainer” sessions; and a quality assurance feedback process.
"It was clear that if you got the right tools and the teaching and you were able to change the culture, it would become part of your practise. And that’s what we were shooting for. Change is hard, but if you never start, you’ll never finish. Sonosite was integral to this process."
Angela Hughes, RN, BSN, MSN, Director, Continuum of Care, White Memorial Medical Centre.
Programme Results: Zero and Zero!
Through the implementation of the central line programme, White Memorial achieved zero iatrogenic pneumothorax hospital wide and zero CLABSI in the ICU.
"Now when we do go over our infection rate and review our central lines, everyone is just thrilled and so proud of our institution. Anybody or any hospital thinking they can’t also achieve zero infections in their ICU is wrong. It is possible."
Rebecca Berberian, Director of Risk Management and Infection Control, White Memorial Medical Centre
The Six-Point Bundle
Central-line bundles, such as the five-point bundle endorsed by the IHI, have been shown to decrease the rate of CLABSI. The Sonosite Central Line Management Training Programme teaches this bundle plus an additional, important sixth step:
- Hand hygiene
- Maximal barrier precautions
- Chlorhexidine skin antisepsis
- Optimal catheter site selection
- Daily review of line necessity, with prompt removal of unnecessary lines
- Ultrasound guidance for line placement
The addition of this sixth point, which the AHRQ and NICE recommends to reduce mechanical complications, is Sonosite's unique and significant contribution to onsite institutional training. Research has shown that, by using ultrasound guidance for central line placements, the risk for cannulation failure, arterial puncture, and other insertion complications is decreased.
"I think that it’s in every physician’s interest to do the best for their patient. By adhering to these six simple guidelines, I think you can achieve marvelous results."
Faisal Khan, MD, Chair, Dept. of Surgery, White Memorial Medical Centre