10-Minute Interview:Minimizing the Risk of Infection at Children`s Sibley Heart Center:Interview with Nicole Jarrell, RNC,

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 catheter-related 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. 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? 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. 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 aspects of your work do you find most rewarding and/or challenging? In the field of pediatric cardiology, 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 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 veno-venous 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. What advancements do you hope to see in the field of cardiology in the future? If I could have my wish, I would be out of a job because we would be able to prevent congenital heart disease! Since this is not likely to happen in my lifetime, the advances that are being made in interventional cardiology are key to avoiding surgery whenever possible. Advancements in all aspects of pediatric cardiology, from diagnostics to surgical techniques and post-operative management, are all vital to improve outcomes for the children we serve. Also, as these children are growing up and becoming adults, the specialty of adult congenital cardiac patients will be vital to their continued health. What advice would you give to allied professionals who are currently at the start of their career? Always challenge yourself and others to identify opportunities to improve your practice the excuse because we have always done it this way is not acceptable anymore. Has anyone in particular been helpful to you in your medical career? The CICU at Children s has the most phenomenal staff that I have ever worked with. The support that staff give each other is unparalleled and unmatched. It is all about what we do for the kids, and that takes teamwork everyone helps the patient in some manner. J. Renee Watson, RN, CIC What were your reasons for choosing to work in Quality and Infection Control? I was practicing in Neonatal medicine, and there was nothing I hadn t done in that field. An Infection Control position had been open for several months in the hospital where I was working and after researching the position, it sounded like a new challenge. I was later promoted to the Director of Quality, which was an easy transition since Infection Control is so evidence-based. Describe your role as Manager of Infection Control and Occupational Health at Children s. What is a typical work day like for you? It is never boring and is always fast. Twelve hours can come and go before you know it. These two areas are highly regulated between CMS, OSHA, NIOSH, and The Joint Commission, so there are always new requirements that need implementation. I am lucky to be a part of a highly skilled team of individuals that perform surveillance, minimize infection risks, ensure employees are free from communicable diseases and are vaccinated according to the CDC Guidelines. I read that you helped provide a detailed assessment of infection risks to the CICU and worked with their staff to create/implement performance improvement initiatives aimed at minimizing these risks; could you describe the infection risks associated in the CICU, and the process you created to minimize these risks? Have you collaborated with other departments or labs as well? A bed to bed assessment with interviews of the staff helped guide the action plan. The bottom line is the clear separation of clean from dirty. We don t often think about these things until an outsider points them out. Some of the items on this plan involved reducing the amount of times an invasive line was entered by consolidating the care that is given, all the way to discarding pacifiers after a certain period of time to reduce oral yeast infections that could cause secondary infections. As always, a good infection control plan involves being proactive rather than reactive. These processes are in effect system-wide, and the Infection Control team gathers monthly to round at the various hospitals in an effort to troubleshoot infection risks at the bedside. How can other labs or hospital departments apply this research to help prevent infections? What is the most important thing for them to remember about preventing infections? The most important issue for anyone to remember is that you do not have to have an MD or RN behind your name to save a life. Never underestimate the impact of good hand hygiene, proper isolation, or the important jobs of our friends in Environmental Services. Are you currently involved with any other research projects at Children s? If so, please describe. We will soon look at the number of asymptomatic patients having central lines who have bacterial colonization and what they are colonized with. What aspects of your work do you find most rewarding and/or challenging? The investigation piece of Epidemiology is always challenging, but is my most favorite. It is powerful to find out the why s so that we may put in place a process that prevents future illness or even death. What other advancements do you hope to see in the future regarding preventing infection? I am looking forward to further advances in cost-effective molecular lab diagnoses to lessen turnaround times. Other than that, we already have the tools we need to prevent infections soap, water, and friction or alcohol hand sanitizers. Has anyone in particular been helpful to you in your career? I have been so fortunate in my career to be in opportune places at opportune times. I have many mentors, such as my current Director, Charlene Roberts and my previous CEO, Robbin Lee who pulled me into Quality Leadership. I also cannot ignore the talented people in the public health system when I worked in Epidemiology. For more information, please visit: www.choa.org