EP Lab Digest - December 2007 - (Page 26)

26 10-MINUTE INTERVIEW DECEMBER 2007 10-Minute Interview: Minimizing the Risk of Infection at Children’s Sibley Heart Center Interview with Nicole Jarrell, RNC, MSN, and J. Renee Watson, RN, CIC Interview by Jodie Elrod Nicole Jarrell, RNC, MSN icole Jarrell, RNC, MSN, is a Nurse Expert in the Cardiac Intensive Cardiac Unit (CICU) at Children’s Healthcare of Atlanta’s Sibley Heart Center. J. Renee Watson, RN, CIC is the Manager of Infection Control/Occupational Health at Children’s Healthcare of Atlanta. Recently Nicole Jarrell, RNC, MSN and J. Renee Watson, RN, CIC conducted research initiatives to minimize the risk of catheter-related blood stream infections in high-risk pediatric patients. N J. Renee Watson, RN, CIC Nicole Jarrell, RNC, MSN Describe your roles in the CICU. What is a typical work day like for you? In the role of nurse expert, I wear various “hats” based on what goals need to be accomplished. It may be spending the day in the unit, providing care, precepting or just being an extra set of helping hands. Othertimes it involves things such as working on research studies, preparing for lectures, or participating in system task forces. Explain your research to help minimize the risk of catheterrelated blood stream infections in high-risk pediatric patients. What were your findings? How did your research come about? I evaluated the number of times that our patient’s lines are entered for blood sampling and medication administration.This averaged 26 times per patient, per day for a total of around 13,000 times per month. This particular risk was not adequately addressed in the BSI bundle implementation. Given the residual efficacy of CHG, we hypothesized that if we used CHG wipes (3.15% chlorhexidine gluconate/70% propyl alcohol) instead of alcohol alone, that the residual effect would extend the protection of the line for the times that staff might not scrub the hub adequately. We adopted a “Take 20” rule: 10-second scrub and 10-second dry before accessing the lines, and trialed this same procedure using both prep products. Of the 170 CHG patients, only 2 had infections versus 7 infections in 125 alcohol patients. As a result of this trial, in January 2007 we converted to an all CHG practice and have had a sustained reduction in our BSI rates. The use of CHG for line access has proven to be effective in reducing this particular risk. However, it takes following all of the current evidenced-based practice interventions in order to maximize the benefit to the patient and reduce the risk for BSI as much as humanly possible. Every employee having contact with the patient has to utilize best practice and be vigilant with the basics of infection prevention, such as hand hygiene and aseptic technique. much of the work that we do is related to congenital heart disease.The technology explosion and resulting advances in this field currently offer hope to families where there previously was none. Everything that we do is always about the kids. The pictures and letters chronicling the lives of the children we have cared for are the ultimate reward, knowing that the care you provided has a lifelong impact on your patients and their families. What additional research is being done at Children’s to help improve the quality of care provided during pediatric cases? Children’s has a dedicated cardiac research staff that supports clinical research within the cardiac division. In 2006, there were over 100 clinical trials conducted. What is the most unusual case you have been involved with? One particular baby stands out that was at a very high risk of infection.This infant had an open sternotomy and required ECMO (extra-corporeal membrane oxygenation), CVVH (continuous venovenous hemofiltration) and multiple central lines for over a month. In the past, prior to the implementation of CHG, patients like this almost always became infected, but she did not. Her story is one that is now regularly repeated with the full implementation of CHG. How can other cardiac labs apply this to their patient care to help prevent infections? What is the most important thing for them to remember about preventing infections? What aspects of your work do you find most rewarding and/or challenging? In the field of pediatric cardiology,

Table of Contents Feed for the Digital Edition of EP Lab Digest - December 2007

EP Lab Digest - December 2007 Improved Anatomical Orientation During AF Catheter Ablation: Experience from Leipzig Heart Center One EP Lab’s Solution to the Administration of Deep Sedation Contents Letter from the Editor Spotlight Interview: Northeast Georgia Medical Center Emerging Technologies for the Electrophysiology Lab The Western Atrial Fibrillation Symposium About the PRECEDE-HF Trial: Interview with William T. Abraham, MD, FACP, FACC, FAHA Overview on Shire and the Discontinuation of Ethmozine®: After the Heart Rhythm Society Intervenes, the Company Changes its Decision Minimizing the Risk of Infection at Children’s Sibley Heart Center: Interview with Nicole Jarrell, RNC, MSN, and J. Renee Watson, RN, CIC Is There a Link Between Gasoline Vapors and Brugada Syndrome? Interview with Darko Kranjcec, MD and Hugues Abriel, MD, PhD New Feature! Pacemaker/ICD Puzzle Email Discussion Group Events Calendar Industry News and Products

EP Lab Digest - December 2007

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