Children’s Hospital finds touchless visual timer increased compliance with the 15 second needleless connector scrub protocol from 7-8% up to 88%
The PRO Applied15 Second Timer, a novel touchless visual countdown timer, has been demonstrated through a study at Boston Children’s Hospital (Use of a Novel Visual Aide to Improve Compliance of 15-Second Scrub of Needless Connectors in Procedural Areas Elizabeth Kelly, MSN, FNP-BC, VACC-BC , Department of Anesthesiology, Critical Care and Pain Medicine Boston Children’s Hospital, Boston, MA) to dramatically improve compliance with the 15 second scrubbing standard of care. Pre-study observations revealed that the 15 second standard was obtained only 7% of the time in an OR setting. Post study observations after the introduction of the 15 Second Timer showed compliance in the OR at 88% (the 12% out of compliance scrub times were due to medication administration urgency).
This is a dramatic improvement facilitated by using an intuitive timing device at the bedside that makes it much easier for the clinician to be able to adhere to the standard of care much more consistently. The 15 Second Timer is visually distinct, easy to read and understand (it is either on and counting down or time is up and it is off) tool that can immediately impact a nurse’s ability to achieve the standard of care. Nursing feedback post study was unanimously positive due to the ease of use and incorporation into existing nursing practice.
When CLABSI occurs in an inpatient setting, the cost to treat the infection is typicallly not covered by insurance because it is cconsidered a preventable infection. On average in the United States, a hospital will experience five CLABSI events per year, resulting in unreimbursed costs of approximately $240,000 per year (or $48,000 per CLABSI). The more critical care beds and ORs that the hospital operates, the more infections and more unreimbursed expenses per year. (Agency for Healthcare Research and Quality)
Critical care nurses, floor nurses, anesthesiologists and vascular access nurses are all trained to comply with the standard of care for cleaning needleless connectors. There are times during treatment or surgery when medication administration urgency outweighs the risk of failing to meet the standard of care. Additionally, when medication administration urgency does not exist, there are other barriers that prevent clinicians from meeting the standard of care.
Those barriers include these types of situations:
- The clock in the patient room is located behind the clinician when they are in the appropriate location to clean the hub.
- Sterile gowns and gloves completely cover the clinician’s wrist watch.
- The clinician is also monitoring vital signs of the patient while performing the scrub, which makes it difficult to track time scrubbing.
- The clinician is interacting with the patient or the patient’s family members, which is also distracting.
- The clinician is counting in their head while scrubbing which results in an inconsistent amount of time spent scrubbing and does not ensure compliance.
- The IV pump offers multiple options for timers, however, that is just another digital readout on a display with multiple digital displays for other functions.
Infection prevention is truly a multifactorial effort (Leapfrog Group Innovators Series: How High Performing Hospitals Turn Hand Hygiene Programs into ROI) and one single intervention or change of practice will not eliminate hospital acquired infections; it requires a broad adherence to protocols and tools that are designed to make that adherence easier to accomplish.
While the Boston Children’s study does not prove that CLABSI will be prevented by the 15 Second Timer, it does prove that the 15 Second Timer is a tool that greatly improves compliance with one critical standard of care that has been proven to prevent CLABSI.