Bridging the gap: a collaborative to reduce peripherally inserted central catheter infections in the home care...

Ochsner Health System agreed to participate in a nationwide collaboration to reduce central line infections in our intensive care units. Our outpatient peripherally inserted central catheter (PICC) infection rate was unacceptably high, so as an adjunct to the nationwide study we attempted to reduce PICC infections in the home care environment. Typically, home health nurses or outpatient infusion centers care for PICCs per protocol. However, no standardized protocol exists, and each facility may have a different way to care for PICCs, leading to varied and inconsistent maintenance.

Key members from our hospital, home health agencies, and an infusion company formulated a plan to reduce outpatient PICC infections. We hypothesized that the only way to reduce infections was to standardize line care and maintenance and to empower the patient to be an advocate for his or her care. The best avenue for achieving standardized care across multiple infusion companies and multiple home health agencies was to develop an order set for PICC care and dressing changes. We also developed a checklist for the nurse and the patient to complete together during dressing changes. The checklist and order set were linked to the hospital's home health discharge orders so that they would print automatically when the provider discharged the patient to home health care.

Baseline data were collected from July 1, 2010, to June 30, 2011. During that time, the infusion company identified 20 PICC infections. In 20,773 line days, the infection rate was 0.963 per 1,000 line days. The new order sets and checklists were instituted on July 1, 2011. From July 1, 2011 through June 30, 2012, 11 PICC infections were identified with 21,021 line days. The calculated infection rate was 0.52 per 1,000 line days. PICC infections so far have been reduced by 46%.

By bridging the gap between inpatient and outpatient care, we reduced PICC infections by 46% in our home infusion patients. We accomplished this result through a collaborative partnership among hospital staff, an infusion company, and home health agencies and a standardized process for line care and maintenance using a PICC home care order set and a patient/nursing PICC care checklist.