Access Site Infections sp Cardiac Catheterization Procedure - PowerPoint - PowerPoint

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					Access Site Infections s/p Cardiac
   Catheterization Procedure
  Team Members:
  Michael Jarotkiewicz  Eric Grassman, M.D.
  Fred Leya, M.D.       George Simon
  Jackie Saulters, ACNP CCL Staff
 Opportunity Statement
Access site infections can be a complication s/p
cardiac catheterization procedure. This gives us an
opportunity to reduce the incidence of access site
infections for our cardiac catheterization lab
patients

Desired Outcome
 To identify the risk factors associated with
 the cardiac catheterization related access
 site infections and to achieve a groin access site
 infection rate of 0.2% or lower
Most Likely Causes for Current
Opportunity
 Patients at high-risk for infection:
   Diabetes
   Obesity
   Age
   Immuno-suppression
   Emergency patients

 Patient groin preparation consisting of shaving
     hair in Holding Area using a safety razor

 Betadine scrub and paint of access site in
     Procedure Room
     Most Likely Causes for Current
     Opportunity

No national standard for surgical hat or mask
    requirements for procedure room staff

No re-prep of groin site prior to Perclose closure
    technique

Deployment of Vasoseal closure device to achieve
    hemostasis on patients that had sheath removal in
    the nursing units
       Solutions Implemented

New protocol for groin preparation in the Holding Area
   developed:
  Hair to be clipped from groin versus shaved
  Groin site washed with Hibiclens soap

New protocol for groin preparation in the Procedure
   Room developed:
  Duraprep scrub solution versus betadine scrub used
   to prep groin in the CCL.
  Duraprep stays on the skin for 72 hours
   maintaining anti-bacterial effects
    Solutions Implemented
Implemented requirements to wear surgical hat and
    mask for procedure room staff
Infection control in-service provided to the CCL staff
    for heightened sterile process awareness
Antibiotics for high-risk patients determined by the
    Cardiology attending/fellow
Manual hold versus deployment of Vasoseal closure
    device to achieve hemostasis on patients that
    had sheath removal in the nursing units
Retrospective observational case control study was
    completed identifying risk factors for infections
    after cardiac catheterization
    Data Analysis and Results

We noticed a decrease in our percentage of access site
infections s/p cardiac catheterization lab procedures
which has remained at 0.0% from October, 2002
through April 2003 due to:

  A change in access site preparation techniques
  Re-prep of access site immediately prior to
      Perclose deployment
  The identification of high risk patients and
      subsequent administration of antibiotic
      agents
Results
        Infection Rate per Procedure

    1
  0.9
  0.8
  0.7
  0.6
  0.5
  0.4
  0.3
  0.2
  0.1
    0
        Jan-02

                 Mar

                       May

                             Jul



                                                               S1
                                   Sept

                                          Nov

                                                Jan-03

                                                         Mar
            Next Steps


Monthly review and discussion of data from
our cardiac catheterization patients for access
site infections.