Carol Vance

Starting small to achieve big results

Carol Vance, RN, BSN, CIC
Missouri Baptist Medical Center
St. Louis, Missouri

Carol Vance created an innovative, nurse-led program to dramatically reduce infections associated with central lines and urinary catheters at Missouri Baptist Medical Center.

Vance’s initiative, called Plastics Rounds, provides a case book example of how to generate buy-in for new infection prevention programs. Targeting catheter-associated urinary tract infection (CAUTI) and central line-associated bloodstream infection (CLABSI), Vance created a multidisciplinary team representing infection prevention, nursing, educators, physicians, lean performance, database analysis, and the Quality Nurse Council, with executive sponsorship. Vance and team members met with key physician groups, physician assistants, and hospitalists to discuss the initiative, and seek input and support.

Plastic Rounds comprised two primary elements. Starting with nurses, the program provided education about proper use of central lines and urinary catheters, promoted critical thinking about the necessity of devices for each patient, and encouraged discussion with physicians when necessity was questionable. Then, for patients who received devices, the Plastic Rounds program emphasized maintenance based on bundles and best practices.

“We leveraged best practices for infection, but also best practices for nurses in general,” said Vance. “We wanted the behavior to integrate into the nurses’ normal workflow.”

The team piloted Plastic Rounds in the medical oncology department, where 13 patients were infected with CLABSI during a 10-month period between 2013 and 2014.

As the program showed results, Vance leveraged them to generate additional support. “We said, ‘This is what the nurses are doing. It’s working, and we need your support,” she says. “The more communication and transparency we had, the more buy-in we got.”

The Plastic Rounds pilot program resulted in nearly $600,000 in savings and zero CLABSI infections in the 11 months post-intervention.

“Success came from starting small and gaining support along the way,” said Vance. “Educate the right audiences up-front about what you want to do and why.”