From the 2021 HVPAA National Conference
Patrick Igharosa (Flushing Hospital Medical Center), Javeria Shakil, Farrah Anwar, Sairah Khadija
Background
A central line associated bloodstream infection (CLABSI) is a laboratory-confirmed blood stream infection unrelated to infections at other sites that occurs within 48 hours of placing a central line (1). Annually, there are approximately 250,000 cases of CLABSI in the United States (2). They are associated with an increase in length of hospital stay, morbidity and mortality, causing 28,000 deaths yearly in the United States (3).
Objectives
To reduce the yearly CLABSI rate by at least 75% in 3 years in the general medical-surgical floors and intensive care units in an inner-city community teaching hospital.
Method
The CLABSI task force – a multidisciplinary team of residents, nurses, infection control and performance improvement personnel – was created. The task force ensured that the updated CLABSI bundle was implemented by all staff involved in patient care. In-depth education on proper and aseptic insertion of central lines was provided to residents and physicians. Daily and weekly rounds occurred on all floors and intensive care units to assess indication, duration and continuous need for central lines. Observation of central line insertion by infection control staff ensured good hand hygiene, use of maximal sterile barrier precautions and aseptic insertion technique. Nurses were educated on proper care and dressing of central line insertion sites with the use of flowsheets and checklists to confirm adherence to all steps. Protocols for the duration of maintenance of central lines according to insertion site were created. A root cause analysis was performed for every CLABSI case to determine if all protocols were followed, if the event could have been avoided and steps that may be taken to prevent similar events in the future.
Results
This quality improvement project commenced in January 2016 and is still ongoing. Data from 2015 is included to show comparison from before the start of the quality improvement project. Figure 1 shows the CLABSI rate from 2015 to 2018. There were 18 CLABSI events in 2015 prior to initiation of the project. The number decreased to 10 CLABSI events in 2016, 6 CLABSI events in 2017 and 4 CLABSI events in 2018, with an overall decrease of 77.8%. The monthly total of central line days in the medical-surgical wards, adult intensive care unit and neonatal intensive care unit and the CLABSI events for the different years are shown in figure 2-5. The types of central line implicated in the CLABSI events are shown in figure 7. Subclavian hemodialysis catheters and peripherally inserted central catheters (PICC) were the most common catheters.
Conclusion
CLABSIs are an avoidable hospital acquired infections. Morbidity, mortality, length of stay and healthcare cost can be reduced by decreasing the CLABSI rates in healthcare facilities. With strict adherence to care bundles and active surveillance, CLABSI rate can be minimized while providing optimal care for our patients.
Clinical implications
By reducing the amount of CLABSIs, patients are not only spared the physical and psychological stress of the infection but also, the side effects of antibiotics used in treating the infections and possibly prolonged length of hospital stay.
