Moderating Factors
Readiness Assessment
Section Summary
- A total of 342 Readiness
Assessments were completed in adult ICUs.
- Units most
frequently reported they had fully implemented inclusion of chlorhexidine in
their central line kit (94.7 percent) followed by use of an independent
line cart or kit stocked with essentials for placing a central line catheter
(83.0 percent).
- Least frequently
reported was the routine bathing of patients in clinical areas with
chlorhexidine (20.7 percent) followed by use of an antiseptic or antibiotic impregnated or coated central catheter
(43.6 percent).
- Units in teaching
hospitals or hospitals with greater than the median number of beds were more
likely to report to the CDC NHSN (p<0.001).
Units were requested to complete a Readiness
Assessment at baseline (go to Appendix G for complete instrument). The Readiness
Assessment was designed to assess adoption of best clinical practices (e.g.,
frequency of bathing patients in clinical areas with chlorhexidine) and prior
exposure to CUSP materials or participation in other CLABSI reduction efforts.
Results
of Readiness Assessments presented below were restricted to adult ICUs and,
when possible, matched to their hospital's 2010 AHA Annual Survey. Utilizing
the AHA survey, units were classified as residing in teaching or non-teaching
hospitals, and the median bed size of the sample was used to classify units as
residing in hospitals with total bed size above or below the sample median. Readiness
Assessment results that could not be matched to an AHA survey were classified
as non-teaching and below the median bed size. Finally, for presentation
purposes, results of the assessment were restricted to items considered most
clinically relevant or pertinent to CUSP implementation. A total of 342
Readiness Assessments were completed among adult ICUs. Forty-five percent of
units resided in teaching hospitals, and the median bed size was 230 (mean=311,
stdev=256). Seven units could not be matched to their AHA surveys.
Survey
responses can be found in Table
19. Most frequently,
units reported they had fully implemented inclusion of chlorhexidine in their
central line kit (94.7 percent). Least frequent was the routine bathing of
patients in clinical areas with chlorhexidine (20.7 percent). Variability in
responses was found based on teaching status and bed size. Units residing in
either teaching hospitals or hospitals with greater than 230 beds were more
likely to report to the CDC NHSN (p<0.001). Units residing in
teaching hospitals were more likely to have participated in an organized
multi-site effort to reduce CLABSI. Finally, units residing in hospitals with
greater than 230 beds were more likely to, 1) use an independent line cart or
kit stocked with essentials for placing a central line catheter, 2) use a line insertion
checklist to ensure compliance with evidence-based practices, 3) use
chlorhexidine impregnated patch for central venous line care and, 4) bathe
patients in clinical care areas with chlorhexidine.
Table 19. Readiness Assessment results
for adult ICUs
| Assessment Question* |
All
(n=342) |
Teaching Status |
Bed Size† |
Non-
Teaching
(n=187) |
Teaching
(n=155) |
p value‡ |
≤230 beds
(n=175) |
>230 Beds
(n=167) |
p value‡ |
| 1 |
Participation
in any organized multi-site effort to reduce bloodstream infections |
43.9% |
20.5% |
23.4% |
0.009 |
20.8% |
23.1% |
0.210 |
| 2 |
Partnership'
with a Senior Executive for patient safety |
49.4% |
26.6% |
22.8% |
0.760 |
24.9% |
24.6% |
0.749 |
| 3 |
Systematic
analysis and proactive learning from harmful events or events with potential
harm as raised by front-line staff (other than M&Ms and official RCA) |
52.3% |
28.4% |
24.0% |
0.849 |
26.0% |
26.3% |
0.574 |
| 4 |
Use of an
independent line cart or kit, stocked with essentials for placing a
central-line catheter |
83.0% |
43.3% |
39.8% |
0.035 |
39.8% |
43.3% |
0.007 |
| 5 |
Inclusion
of chlorhexidine in central line kit |
94.7% |
51.5% |
43.3% |
0.573 |
47.4% |
47.4% |
0.066 |
| 6 |
Use of a
line-insertion checklist to ensure compliance with evidence-based practices |
80.1% |
41.2% |
38.9% |
0.016 |
37.7% |
42.4% |
0.002 |
| 7 |
Does your
hospital participate in reporting to the CDC NHSN? |
54.1% |
24.9% |
29.2% |
<0.001 |
22.8% |
31.3% |
<0.001 |
| 8 |
Does your
ICU/Clinical Care Area currently use a chlorhexidine impregnated patch for central
venous line care? |
67.5% |
34.2% |
33.3% |
0.031 |
30.1% |
37.4% |
<0.001 |
| 9 |
Does your
ICU/Clinical Care Area currently use antiseptic or antibiotic impregnated or
coated central catheters? |
43.6% |
24.0% |
19.6% |
0.908 |
22.8% |
20.8% |
0.701 |
| 10 |
Do you
bathe patients in this clinical care area with chlorhexidine? |
20.7% |
8.8% |
12.0% |
0.018 |
7.0% |
13.7% |
0.001 |
* Items 1-7 are considered a positive response if reported as
"fully implemented" and items 8-10 are considered a positive
response if reported as "Routinely."
† Total hospital beds median for sample used for stratification
(median = 230, mean = 311, stdev = 256).
‡ Statistical significance considered at p<0.01 level.
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