Face Off Against Central Line Associated Bloodstream Infections

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Primary Author:</td>
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Karen Buckley, RN</td>
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Co-Principal Investigators/Collaborators:</td>
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<p align="left">Josephine Melchione, RN, Thomas Bily, PA, Arlyn Dimatulac, PA</p>
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Organization:</td>
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North Shore University Hospital</td>
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Abstract</h2>
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Purpose</h3>
<p>North Shore University Hospital identified Central Line Associated Bloodstream Infections (CLABSI) as a major quality improvement initiative in 2013. The intensive care unit (ICU) SIR rate for 2012 was 0.66, and for non-ICU was 0.558. The goal of this initiative was to reduce CLABSI rates to zero and to achieve 100% staff compliance with insertion and maintenance bundles. </p>
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Background</h3>
<p>Central Line Associated Bloodstream Infections is ranked among the most deadly of hospital acquired infections. Although the incidence across the United States has been reduced, these infections continue to produce serious morbidity, and elevate costs to patients and health care institutions.</p>
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Materials & Methods</h3>
<p>An inter-professional CLABSI task force was formed to assess current state. A wide variation in clinical practices, processes, and utilization of materials was discovered. The task force first focused on the enhancement of the central line maintenance bundle. This included fortification of hand hygiene and aseptic technique during shift site assessment and dressing and injection cap changes. The team added daily chlorhexidine baths for all patients with central lines, created standardized central line dressing kits, delegated central line dressing changes to the IV team, and incorporated daily review of central line necessity during interdisciplinary rounds. Frontline staff were instrumental in selection of new products and packaging of revised central line dressing kits. New products incorporated into standard practice included chlorhexidine impregnated protective discs, an improved occlusive dressing, and an alcohol saturated port protector. Education was provided to all end-users through vendor support, daily rounds, Best Practice Showcase, and Physician/Nursing Grand Rounds. Compliance with insertion and maintenance bundles was accomplished through daily rounding.</p>
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Results</h3>
<p>Compliance with maintenance bundles and infection rates was collected. Reduction in SIR rate was achieved. 50% reduction in ICU CLABSI rate was noted, along with a 60% reduction in hospital SIR rate. </p>
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Conclusion</h3>
<p>This quality improvement initiative was started in July, 2013. From August through December, 2013 there were zero CLABSI.</p>
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Bibliography</h3>
<ul>
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CDC. CDC, (2013). Central line-associated bloodstream infection event</li>
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Dunmont, C., & Nesselrodt, D. (2012). Preventing central line-associated bloodstream infections. Nursing, 41-46.</li>
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Koll, B., Straub, T., Jalon, H., & Block, R. (2008). The clabs collaborative: A regionwide effort to improve the quality of care in hospitals. The Joint Commission Journal on Quality and Patient Safety, 34(12), 713-723.</li>
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Ritter, G., Kuncewithc, M., Roditi, A., Roditi, A., Biley, T., Lennon, I., Wolff, E., Laumenede,</li>
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T., Barrera, R. (2013). A Central Venous Catheter Line Protocol by the Surgical Continuum of Care and Nursing Decreases Line Infection/Complications in All Hospitalized Patients. ICU Director. 10(10), 1-7.</li>
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Wright, M., Tropp, J., Schora, D., Dillon-Grant, M., Petereson, K., Boehm, S., Robicsek, A.,</li>
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Peterson, L. (2013). Continuous passive disinfection of catheter hubs prevents contamination and bloodstream infection. American Journal of Infection Control, 41, 33-38.</li>
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APIC. (2009). Guide to the Elimination of Catheter-Related Bloodstream Infections.</li>
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<p>© Improvement Science Research Network, 2012</p>
<p>The ISRN published this as received and with permission from the author(s).</p>