Authors (including presenting author) :
Wong SF(1), Li SC(1), Leung SL(1), Wu CM(1), Yeung MW(1), Lee CH(1), Kwan YF(1), So HM(1), Yan WW(1)
Affiliation :
(1)Department of Intensive Care (2)Pamela Youde Nethersole Eastern Hospital
Introduction :
Hemodialysis (HD) and Continuous Renal Replacement Therapy (CRRT) are common therapies in ICU. The connections between HD catheter and bloodlines were wrapped by Povidone-Iodine Soaked Gauze (PISG) and transparent dressing. This conventional method was believed to provide better protection for patients against catheter associated blood stream infection (CABSI). However, no available evidence supports this method. Besides, it hindered early detection of leakage from connections and was difficult to remove it during assessing catheter patency. The prolonged time in handling the circuit might result in “circuit clotted”. Therefore, the project aims at improving quality of patient care by reviewing the current practice and streamlining the HD catheter disinfection practice.
Objectives :
1. To streamline HD catheter disinfection procedure by abandoning the conventional method (“Less”). 2. To implement evidence-based practice of “Scrub the Hub” Technique on HD catheter disinfection (CDC, 2011).
Methodology :
All ICU nurses who were involved in the HD and CRRT procedures received a briefing on the new method using educational slides, video and poster in December 2017. New Method is summarized as follow: Initiation Procedure: Disinfect the hub with cap with Povidone-Iodine Soaked Gauze (PISG) for 3 minutes prior to cap removal then rub the hub with alcohol pad for 15 seconds. Termination Procedure: Disinfect the catheter connection with PISG then rub the hub with alcohol before applying new cap. During Therapy: Abandon to wrap the catheter connections. After Therapy: Wrap catheter caps with sterile gauze and secure with Micropore. Compliance audit and satisfaction survey were conducted. The CABSI rates of the pre and post implementation periods were monitored.
Result & Outcome :
The new practice has been implemented since January 2018. Most of the audit items were compiled (n=27). Nurses were satisfied with the new practice with a mean score 5.33 out of 6. The post CABSI in 1Q and 2Q 2018 achieved zero rates. The nil increase in CABSI rate proved that the new practice is adoptable. A silent observation on the new practice was done in December 2018. The nurses’ compliance on catheter emergency disconnection and re-connection care should be reinforced. Reinforcement had been done by bedside coaching and highlight in department meetings. Furthermore, promotion poster with slogan of the procedure was designed and launched in January 2019.
Co-location with:
