LEAN Processes, Evidence and Audit Feedback to Achieve Reduction in Catheter -Related Blood Stream Infection Markers

Purpose:
Dramatically reduce catheter-related blood stream infection (CR-BSI) markers in people diagnosed with renal and metabolic disease, integrating LEAN processes to maximize adherence to evidence-based bundle.

Significance:
Stage 5 chronic kidney disease rates reached 360 per million population in 2006 (USRDS, 2008). Poor vascular access and widespread hemodialysis (HD) catheters increase risk for CR-BSIs (Manierski & Besarab, 2006). Death from sepsis in HD patients is 100 times that of the general population (2006).

Strategy and Implementation:
In a large community hospital, data analysis suggested increased CR-BSI markers. A field study conducted by a CNS and infection control practitioner revealed multiple non-value added steps in a complex work environment negatively influencing adherence to evidence-based practice. It is well researched that nurses are interrupted every three minutes, including to gather supplies (Tucker, 2006). CNS interviews with direct care nurses revealed nursing knowledge deficits with Kidney Disease Outcomes Quality Initiative (KDOQI)guidelines for accessing HD catheters. In response, using LEAN processes dramatically influenced by direct care nurse engagement, supplies key to compliance were trialed with overwhelming success and satisfaction. As a result, compartmented bins were installed in all patient rooms. KDOQI guidelines for accessing HD catheters were integrated into policy and were reviewed with bedside and hemodialysis staff, and supplies for povidone iodine soaking were made available.

Evaluation:
Using MedMind™ Data Mining, nosocomial infection markers were followed through 2008 and resulted in a 62% reduction. Adherence to EBP standards improved to greater than 90% per bundle audits conducted by staff. Nurse satisfaction increased as evidenced by positive feedback and use of supplies.

Implications for Practice:
LEAN processes can be easily introduced in complex work environments such as acute care hospitals. LEAN processes encourage staff to become involved with work area improvements, creating changes that are sustainable while spreading and adopting EBP at the bedside (Herring, 2006).