Rub-a-Dub-Dub: Scrub the Hub

Purpose:
The purpose of this strategy was to identify innovative methods to achieve and maintain zero Central Line Bloodstream Infection (CLBI) in our Medical Intensive Care Unit.

Significance:
Hospital acquired infections (HAI) are nurse sensitive. HAI are no longer reimbursed, lead to increased morbidity, mortality, length of stay, and costs. The importance of addressing this issue is evident in lives saved, increased customer and employee satisfaction, and decreased costs.

Strategy and Implementation:
Our proposed strategy incorporated the elements of the central line bundle outlined in the nursing literature. These evidence based approaches are instrumental in providing safe, timely, effective, efficient, and patient-centered quality care. We felt that in order for our “scrub the hub” campaign to be a success, it had to be staff driven by unit based practice champions. Moreover, if bedside staff nurses understood the NDNQI data results and how their practice influences patient outcomes, then we would attain more “buy-in”. Our staff champion and unit leadership team identified elements within the central line bundle that were “must-haves”. Staff education incorporated different teaching strategies including inservices, skills validation, “walking-billboard”, unit newsletter, audits, and more. Staff council input led to increased accountability, bedside report, and regular exposure to our NDNQI results.

Evaluation:
Our Central Line Bloodstream Infection rates (CLBI) varied prior to implementing the central line bundle in July 2008. At that time our CLBI rates dropped from a high of 9.009/1000 days to 3.448/1000 days. Since implementing our “Scrub the Hub” campaign in January 2009 we have not seen any CLBIs.

Implications for Practice:
NDNQI results empower bedside nursing staff with a visual depiction of how their care directly influences patient outcomes. Using NDNQI results plus evidence based nursing practices engages and transforms the staff nurse from task master to engaged professional.