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Reducing Central Line Associated Blood Stream Infections in a Major Academic Facility Using a Novel Comprehensive Tool

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      Background

      Central line-associated blood stream infections (CLABSIs) are a major source of morbidity, mortality, and increase in cost for healthcare facilities. At our facility, a multi-disciplinary team created a comprehensive tool to prevent higher than expected number of CLABSIs.

      Methods

      This quality improvement project was conducted at a 953 bed- Level 1 Trauma Teaching Facility, in the 105- bed adult intensive care units (ICUs). On August 2017, a novel comprehensive tool to reduce CLABSI was created by a multi-disciplinary team. The tool was implemented in January 2018.
      A multidisciplinary team (nurses, vascular access team, physicians, infection prevention), collaborated on CLABSI prevention. The first step was performing Apparent Cause Analysis (ACA) for CLABSI cases. The ACA identified the following improvement opportunities: Device indication, insertion bundle completion, device access, dressing best practices, daily audits, necessity for central lines in patients leaving ICUs, prompt removal of emergent lines (femoral), standardized line insertion and dressing kits, Chlorhexidine Gluconate (CHG) daily bathing, timely identification of CLABSI and posting unit specific CLABSI run charts, and patient education. ACA findings were remediated with staff education (flyers, just-in-time), and the Kamishibai CLABSI maintenance Audit Tool (K card).

      Results

      Statistically significant reduction in the number of CLABSIs was reported in 2019 (P-value 0.003). In 2016 and 2017, the ICUs reported a Standard Infection Ratio (SIR) of 2. In 2018 and 2019 up to September, the ICUs reported a SIR of 1 and 0.9 respectively. The observed CLABSI reduction was >50% with a decrease from 42 in 2016, to 34 in 2017, to22 in 2018 and 13 in 2019.

      Conclusions

      Utilizing ACA, involving front-line staff and leadership, providing just-in-time education to targeted staff, continuing education, and ensuring the appropriate audit tools (K card) are in place, enhances staff awareness, resulting in a significant reduction in CLABSI rates.
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