Atherton SL, Tjoelker RC. Evidence Based Fact Sheet: An Effective Method for Implementing Change. American Journal of Infection Control. 2006;34(5):E51.
ISSUE: One intervention our hospital used to decrease central line related (CLR) blood stream infections (BSI) in our intensive care unit (ICU) was use of a 2% chlorhexidine preparation for skin antisepsis for catheter insertion and dressings as recommended by the CDC Guidelines for Prevention of Intravascular Catheter-Related Infections. We wanted to expand use of the product throughout our hospital to include all types of catheter insertion and care, skin preparation for minor procedures, and blood cultures. Effective education to implement the change was needed.
PROJECT: We developed an Evidence Based Fact Sheet (EBFS) to provide concise, comprehensive education. The EBFS included a product description; advantages, and indications and contraindications for use. The EBFS included key references, a summary of our ICU outcomes, and references that supported cost effectiveness. The EBFS listed the Infection Control Practitioner (ICP) as a resource. The EBFS was distributed via our electronic announcement system, mailed to key staff, and posted in supply rooms where the product was stocked. The supply division notified staff of the change and discontinuation of the alternative product. The EBFS was also posted on our intranet site for ongoing access
.RESULTS: The EBFS and hospital wide use of the chlorhexidine product was implemented January 2005. The ICPs collected surveillance data on hospital wide BSIs and blood cultures to monitor effectiveness. The ICU CLR BSI rate decreased from a cumulative infection rate of 3.0 per 1000 device days in 2004 to 2.4 in 2005. Hospital wide BSIs from all sources decreased from 17 to 8 per quarter in 2005 as compared with the previous historical range per quarter as high as 25 BSIs. Peripherally inserted central catheters (PICCs) BSIs decreased from 3.0 BSIs per 100 PICCs placed in 2004 to 0.6 in 2005. The blood culture contamination rate per 100 bottles decreased from 2.4 in 2004 to 1.6 in 2005. A six month evaluation of the EBFS yielded positive comments about the value of the EBFS as an education tool.
LESSONS LEARNED: Utilizing an EBFS is an effective way to provide education and evidence for a hospital wide Infection Control intervention. The time involved to develop the EBFS was minimal and it remains an available, valuable resource for staff.