In a recent thread, xjohns1 commented about how UCSF CCM incorporated the current steps to reduce catheter related blood stream infections but didn't utilize a formal checklist. I'm curious what the practice is at other institutions, and what people think of using a checklist to ensure uniformity in practice.
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The Checklist
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We have a strict policy at my hospital. The checklist must be completed by the nurse assisting (and signed by the operator) or by the operator if done alone. The checklist includes washing hands prior to insertion, using cap/mask/gown (including cap/mask for all people present in the room and a cap on the patient's hair as well), placement of a "sterile procedure in progress" sign on the door, etc.
If the form is not placed in the chart, then the central line must be replaced within 12 hours... no questions asked.
If the form is not placed in the chart, then the central line must be replaced within 12 hours... no questions asked.
At the VA STRICT adherence to the check list, and the Uni hospital, it's still a work in in progress. We use the list, but it often gets forgotten.
i should clarify: there is a form of a checklist in our procedure note template. it has yes/no check boxes to indicate compliance with the elements of the common central line guidelines: chlorhexidine, hand hygiene, full drape, etc. since it's a procedure note, of course it's usually completed after the procedure, so its benefit is mostly for the person who completed it to review the correct procedure 'for the next time.' the data from this note are submitted to our state department of health for epidemiologic purposes. further, there is a formal policy that the icu rn can enforce a 'hard stop,' meaning that if the operator is not in compliance with an element of the 'checklist,' he may prevent the operator from proceeding until she is in compliance. i've not seen this happen. all cvc's must be supervised by an icu fellow when the primary operator is a resident (yes, even a senior anesthesia resident) or an np.
