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We are in the process of developing a CVC insertion checklist /bundle. We have sourced a few checklists from major metropolitan hospitals which state that a theatre-type hat should be donned along with mask, gown and gloves prior to insertion. Currently hats are not a part of the standard required attire for those inserting CVCs at this hospital. What are other people doing and if it is part of your procedure is it enforced and are staff complying? Does anyone has any definitive evidence to support wearing of hats to cover hair as improving outcomes for patients and resulting in a reduction of infections?
Cathy Mowat
Infection Control
Central Gippsland Health Service
Sale 3850
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Hi Cathy
These replies to a similar question on a ICU discussion list have been provided by Tim Spencer (who is a member of this discussion list as well). Please contact him for any further information. I have removed the names of the respondents (except for Tim’s reply).
Reply 1
ANZICS and ANZCA both recommend full precautions in their guidelines, if your physicians refuse to gown up including mask and hat then send them back to their peers!Hat and mask were initially the greatest hurdles when I instituted a CLAB prevention campaign here in the late 2000’s. This only improved with use of a champion (HOD was on posters), passive eduation – posters and flyers, and unadulterated bribery -> when nurses audited an insertion the form was collected and then there was a prize (bottle of wine or movie tix) for the physician with first 100% compliant insertion drawn each month. This lasted for about a year until compliance became standard practice. We had 18 months CLAB free at once stage during the program, and our rate remains around the benchmark.
Formal education with medical staff was initally met with resistance and some very strong personalities. I can not oversell the importance of stressing the levels of evidence for your recommendations in the bundle during such sessions!
Nursing staff were intially fearful of becomming “insertion police” but recognised the importance of full barrier precautions and quickly took up the gauntlet to assist with insertion auditing. Nurses who participated in quizzes and crosswords were also awarded prizes for 100% correct responses, these were simply freddo frogs and the like with regular movie ticket draws.
The ANZICS insertion guidelines are attached. ANZICS have a CLAB prevention project, head to their site -> http://www.anzics.com.au/safety-quality/clab
Reply 2
Cap, mask and protective eyewear (for the head) is a minimum in CVAD care bundles.
CRBSI rates have been significantly reduced utilising these 3 accessories, along with sterile gown and gloves. Plenty of literature published and on the web.
Along with maximal barrier precautions of a full body drape, this protects patient and proceduralist.Also of note is that if another clinician enters the room, they must do so with a cap and mask minimum.
All important considerations in reducing CLABSI.
Regards,
Tim..Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.auReply 3
Use of full barrier precautions not only includes patient but also clinician, so mask / cap etc. are part of the fashionable attire.We introduced this state wide here in NSW during the CLAB ICU project
Lots of stuff on the CEC website:
http://www.cec.health.nsw.gov.au/home
Also look at http://www.clabsi.com.au – the ANZICS site on all of this stuff (hopefully still works although I had trouble getting on the other day)
I hope these replies are useful. Cross posting between specialty discussion lists can certainly be interesting!
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailWe are in the process of developing a CVC insertion checklist /bundle. We have sourced a few checklists from major metropolitan hospitals which state that a theatre-type hat should be donned along with mask, gown and gloves prior to insertion. Currently hats are not a part of the standard required attire for those inserting CVCs at this hospital. What are other people doing and if it is part of your procedure is it enforced and are staff complying? Does anyone has any definitive evidence to support wearing of hats to cover hair as improving outcomes for patients and resulting in a reduction of infections?
Cathy Mowat
Infection Control
Central Gippsland Health Service
Sale 3850
Ph (03) 51438518Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
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