Strength in Nurses

Maureen Larkin, for HealthLeaders Media, April 30, 2008

There are more than 250,000 cases of catheter-related blood stream infections among American hospital patients each year, the CDC says. That's why, when your hospital goes 26 months without one, people notice.

Sutter Roseville Medical Center in Roseville, CA, is another one of the "zero heroes" I was introduced to recently. Under the leadership of Sophie Harnage, RN, BSN, clinical manager of infusion services, nurse-driven specialty teams have taken the facility's CRBSI rate from 11 in 2005 to zero during the last two-plus years.

The secret to SRMC's success is a bundle created by Harnage and documented in the Journal of the Association for Vascular Access in December 2007. Its steps include using peripherally inserted central catheters, ultrasound to select insertion sites, surgical-like coverage of both the patient and caregiver, a two-step cleansing and disinfection process, disinfection of the IV connector septum, and daily monitoring of the catheter line.

SRMC's nurses used to use traditional methods to determine where on the arm to insert a catheter, Harnage says. "But two years ago, we went 100% ultrasound . . . It was a big move to make that rule."

Before nurses are allowed to administer the PICC lines they must take a course on the ultrasound-guided technology and demonstrate they are competent in the procedure. Members of the team must also commit to following the steps included in Harnage's bundle.

The result, Harnage says, is an infection rate that hasn't moved from zero in more than two years and a nurse-driven team that is engaged and involved in keeping patients free from infection. "It empowers the team and excites the team," Harnage says. "They're very proud of their high success rate and the skill that they possess."

To come up with her bundle and the specialty team approach, Harnage says she spent a lot of time talking with her colleagues from hospitals all over the country. "I did my homework by asking various medical centers from around the country to ascertain best practices," she says. She gives credit to the many nurses who gave her an inside look at how their hospitals are working to fight infection.

The success that her team has experienced at SRMC gives Harnage hope that other hospitals can also become "zero heroes." She advocates for hospitals empowering nurses to lead the way in infection control.

"We have to take control of lines through assessment, insertion, and removal," she says. "Only specially-trained nurses offer this kind of consistency."

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at
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