Rane Snyder, a nurse in the adult burn unit at Johns Hopkins Bayview Medical Center, shows Richard Bennett, hospital president, how to prepare to change the dressing for a wound—a process that can take as long as 40 minutes. The recent demonstration celebrated a significant patient safety milestone at the burn center: three years without a central line-associated bloodstream infection (CLABSI). Such an accomplishment is particularly difficult to achieve with burn patients, according to patient care manager Kelly Krout. “Preventing a CLABSI is difficult enough, but preventing a CLABSI in a patient who has no skin—the body’s largest defense mechanism—is almost impossible,” she notes. Krout credits the unit’s success to a five-year quality improvement project and improved communication among burn team members.
The Burn Center has been involved in a quality improvement project related to CLABSIs since 2011. The plan includes daily reviews of line necessity, introduction of an antimicrobial-coated catheter, full barrier precautions for central line insertions and scheduled line changes, among other interventions. Physicians implemented an early excision and autografting of the neck and clavicle to help ensure intact skin for placing a catheter. Nurses began weekly audits of all central lines, with feedback in real time.
In 2014, the Burn Center reached its goal of reaching and sustaining a zero CLABSI rate, which it has now maintained for three years.
“Perhaps the most underrated intervention has been the improved communication among all members of the interdisciplinary team,” says Krout. “No member of the team is afraid to speak up and say that a central line needs to be changed.”