National Patient Safety Goal 7: Three Easy Tips for Compliance

Healthcare-associated infections (HAIs) represent a growing concern within the healthcare community. Nurse Managers are on the frontlines of the battle against HAIs and need to understand and interpret NPSG 7 to help their hospitals prevent infections and facilitate compliance with these requirements.

In 2009, three new requirements were added to NPSG 7. These three requirements are to be fully implemented by January 1, 2010.

• Implement evidence-based practices to prevent healthcare-associated infections due to multi-drug resistant organisms (MDROs) in acute care.
• Implement best practices or evidence-based guidelines to prevent central line-associated blood stream infections (CLABSIs). This requirement covers short- and long-term central venous catheters and peripherally inserted central catheter lines
• Implement best practices for preventing surgical site infections (SSIs).

For each of these new requirements, there are three actions that Nurse Managers can take to facilitate compliance and – even better – protect patients.

MDROs

1. Educate your staff about MDRO colonization and infection. Ask the Infection Preventionist in your organization to attend your staff meeting and talk to your staff about the difference between colonization and infection, as well as the critical measures they must take to prevent transmission. This will help your staff better educate patients and families about MDROs.
2. Know your MDRO prevalence data. How often are MDROs present on your unit? What are the common sites of infection or colonization?
3. Observe patient care practices, especially hand hygiene and isolation practices. Make it a habit to round on your unit, giving feedback – good or bad – to your staff members about their practices. Let your staff know you are watching. Remember, people do what you inspect, not what you expect.

CLABSIs

1. Know your policies regarding central line insertion and care. Periodically quiz your staff members on their knowledge, perhaps rewarding correct answers with a piece of candy or gum.
2. Spot-check your patients with central lines to see if policies and procedures are being consistently carried out. Are hubs and ports being disinfected before being accessed? Are non-tunneled central line dressings transparent? Are these being changed and site care performed with a chlorhexidine-based antiseptic every 5-7 days (more frequently if the dressing is soiled, loose or damp) and gauze dressings changed every 2 days (more frequently if the dressing is soiled, loose or damp)?

Check every patient with a central line DAILY to evaluate whether the line can be discontinued. If the line is not essential, get it out.

SSIs

1. For hair removal, make it easy to find and use the right equipment (clippers) and impossible to find or use the wrong equipment (razors). Have a designated storage/charging area for the clippers and the disposable blades.
2. Although pre-operative bathing with chlorhexidine-containing products is an unresolved issue in the guidelines for surgical site infection prevention, when physician orders call for the use of a pre-operative bath or shower, make sure you have the correct products on hand.
3. Give prophylactic antibiotics on time. Pre-operative antibiotics should be administered within 60 minutes of incision (not within 60 minutes of going to the pre-op area). 120 minutes are allowed for vancomycin and fluoroquinolones.

The evidence-based science for preventing healthcare-associated infections is there. The challenge for nurses is efficient and consistent implementation of best practices. Nurse Managers play a key role in establishing a unit-based culture of zero tolerance for healthcare-associated infections. These simple strategies will go a long way in preventing infections and protecting patients.