From the 2024 HVPA National Conference
Rabie Kilan, Master (JHAH)
Team Members
Zainab Abbad, Fatima Al Rashid, Shantymole Mathew, Dr. Mustaf Ghazal, Randah AlQahtani, Annu Jacobs, Marna Saludares, Myla Mantaring, Bemol Vattakunnel, Savera Arian, Ahmad Abu Jaber, Rabie Kilan, Khaled Abu Ajamieh.
Special thanks to all 5B staff and Mr. Hani Ayad for sponsoring the project.
Introduction
Central Line Associated Blood Stream Infection (CLABSI) remains one of the most challenging Hospital Associated Infections (HAIs) globally. This is particularly true for oncology patients undergoing chemotherapy due to suppressed immunity, which makes them more susceptible to infections.
In the first half of 2023, the JHAH Oncology Unit 5B noticed the rate of CLABSI increase to 3.24 per 1000, well above the JHAH benchmark of 1.40 per 1000 device days. This marked increase, which resulted in six cases, emerged as a significant risk and safety concern as of monitoring conducted prior to the 2023 Comprehensive Unit-based Safety Program (CUSP) project. An initiative to reduce the rate was started.
Aim
Reduce the CLABSI rate by 25% within the next six months, targeting a decrease from 3.24 to less than 2.43 cases per 1000 days.
Methodology
A retrospective study for all CLABSI incidents was conducted from January-June 2023, and the six cases were reviewed and analyzed for the type of infection, time to event days, type of bacteria, and line (Peripherally Inserted Central Catheter (PICC) line or Porta Cath). In addition to that, concurrent observations and audits were conducted regularly, and the results were shared with all staff.
Multi-disciplinary meetings, involving individuals from clinical staff to administration, were held to analyze the data, during which case-specific risk factors were identified and tailored, comprehensive interventions were developed. The project began with the Plan-Do-Study-Act (PDSA) method.
A survey was conducted to collect feedback from the frontline staff regarding the contributing factors for CLABSI.
Root Cause Analysis
Main Findings
- Noncompliance with CLABSI Bundle
- Out of stock items
- Non-compliant patients and watchers with infection control standards
- CLABSI Bundle documentation
- Staff shortage
- Improper room and equipment cleaning
- Admission criteria and accepting non-oncology patients with infections
Actions
- Develop Central Venous Access Device (CVAD) care educational handouts for patients and families
- Require staff to complete JHAH online eLearning VAD care module
- Require CLABSI and VAD care be included as a standing item in unit weekly huddles
- Require reporting in DATIX for any improper dressings of transferred patients
- A VAD team was formed
- Require that a urine culture be collected when central blood cultures are collected
- Require daily cleaning (including logging) of medical equipment
- Require compliance with Oncology Unit admission criteria
- Conduct daily evaluation for the need of the watchers
Result
The Infection Control Reports conducted during the six months prior to the project indicated that 5B experienced six CLABSI events. During the six months post-implementation, there was only one CLABSI. The goal is to reach and sustain a level of zero CLABSI events.
Conclusion
Advances in the medical field bring new challenges, including a potential increase in Hospital-Associated Infections (HAIs), specifically Central Line-Associated Bloodstream Infections (CLABSI) in Oncology Units. Proper training and staff preparation are essential before the implementation of new medical equipment to mitigate these risks. By implementing these procedures and ensuring compliance, infection rates can be reduced, leading to a decrease in morbidity and mortality rates.