About CVAD
Background
Healthcare Associated Infections (HAI) are a significant and growing burden on the healthcare system. In Australia approximately 150,000 Healthcare Associated Infections contribute to 7,000 deaths each year. In both paediatric and adult patients, 20 - 40% of these infections are associated with Central Venous Access Devices (CVAD).
In 2007 the CVAD infection rate was 4.5/1000 in the RCH Neonatal Unit and 4.0/1000 in the RCH Intensive Care Unit which translates to approximately 30 individual episodes of line-related infections per annum. The mortality rate varies with the causative organism but is in the order of 10%.
Surveillance data from our ICU and NNU and Oncology and General Medical Wards have shown that we have a measurable problem with CVAD-related infections. While these rates are decreasing with time and are within published benchmarks, we believe that they can be improved further and move RCH to the cutting edge of CVAD management.
The most effective means of reducing CVAD-related infections is the application of a group of evidence-based interventions known as “bundles”. These initially proved to be successful in the adult intensive care setting where infection rates were reduced to zero for many months. More recently these bundles have been modified for use in the paediatric environment and have proven to be equally effective.
RCH CVAD Program Objectives
A coordinated management and monitoring program at The RCH should largely eliminate line-related infections and ultimately, other complications of central lines including line thrombosis and mechanical failure.
The RCH CVAD Program goals include:
- Reduction in the incidence of CVAD infections to 1 per 1000 line days in NNU and ICU by June 2009
- Consistent measurement of CVAD infection rates in all areas of the hospital by December 2009
- Reduction in the incidence of CVAD infections to 1 per 1000 line days in all clinical areas by December 2010
- Determination of the rate of symptomatic line thrombosis per insertion by December 2010
- Determination of the rate of mechanical failure (leakage, breakage) by December 2010
RCH CVAD Key Performance Indicators
The key performance indicators are:
- Review the RCH CVAD line insertion guideline according to the most recent evidence
- Review the RCH CVAD line maintenance guideline according to the most recent evidence
- Document all available CVAD products used at RCH and analyse this to ensure only the safest devices are being inserted
- Development of an educational tool and credentialing process for those engaged in CVAD line insertion
- Development of an educational tool and credentialing process for those engaged in CVAD line management
- Undertake a ‘current state’ assessment for line insertion and management across all clinical areas of RCH
- Designate CVAD champions in each clinical area where these do not currently exist
- Develop a change management plan for each clinical area with the emphasis on local engagement and a focus on removing barriers to compliance with the RCH guidelines
- Development of audit and data collection tools for measuring compliance with interventions and infection rates
- Development of a robust and sustainable mechanism for ongoing audit, data collection, analysis and feedback to staff.
A multi-disciplinary Steering Committee has been established consisting of nursing and medical staff from the primary clinical areas that are involved in CVAD insertion and management – ICU, NNU, Surgery, Anaesthetics, Oncology, Respiratory, Haematology, Medical Imaging and Gastroenterology. Dr Peter McDougall is the Executive Sponsor of the Program which will be jointly coordinated by the RCH Infection Control Unit and the Quality Unit. We envision it will take 2 years to fully implement the program across the RCH.
Progress
PICU CVAD infection rates
NICU CVAD infection rates
