A team approach to preventing healthcare acquired Central Line Associated Bloodstream

Hospital Acquired Infections (HAIs) are a major public health concern because of increased morbidity, mortality, length-of-stay, and financial burden. Central Line Associated Bloodstream Infections (CLABSIs) are among the most troubling of HAIs. An estimated 71,000 (CLABSI) occur in the United States annually resulting in some 33,000 deaths and approximately $2 billion in healthcare costs. In 2010, Harlem Hospital Center, a 282 bed urban acute care facility, had a CLABSI rate of 6.8% as compared to National Health Care Safety Network (NHSN) rate of 2.1 /1,000 line days. A risk assessment was done and the following goals were set: a) reduce CLABSI rate in Adult ICU and Non-ICU patients by 50%; and b) achieve 95% or greater compliance with use of CLABSI Prevention Bundle. To achieve our goals we: a) educated staff on ‘best practices’, b) utilized Central Line Bundle, c) reinforced and monitored Hand Hygiene, d) monitored use of maximal barrier precaution; e) used Chlorhexidine skin prep; f) conducted daily reviews at multidisciplinary rounds, g) ensured timely removal of lines; h) reviewed all CLABSI cases with clinical teams; i) empowered nurses to stop procedure if non-compliance with central line protocol was observed; and j) conducted daily inspection and documentation of site dressing.Over a period of 12 months we surpassed our goal, achieved a rate of zero CLABSI per 1000 central line days, and maintained this rate hospital-wide for over 36 months.Hospital acquired infections contribute to extended length of stays, additional costs, and unhappy patients and families. Our results show that when best practices are adhered to CLABSIs can be prevented.

INTRODUCTION/ABSTRACT

LOGO #1

OBJECTIVES

METHODS

Figure 1: Unit Level CLABSI SIR/CAD (July 2014 – June 2015)

RESULTS

CONCLUSIONSEvidence Based interventions are effective in preventing healthcare related infections, promoting high quality patient care, and reducing hospital costs.

Hospital acquired infections contribute to extended length of stays, additional costs, and unhappy patients

The CLABSI initiative interventions in the ICU contributed to reducing our central line associated bloodstream infections from 6.8 per 1000 device days in 2010 to 0.00 per 1000 device days in 2011 and remained at 0.00 for over 36 months.

In January 2015, the Centers for Disease Control and Prevention National Healthcare Safety Network surveillance definitions were revised, as a result of which most hospitals would see an increase in their CLABSI cases. Harlem Hospital Center experienced an increase in the number of cases classifying as CLABSI during the First Quarter 2015. That is, the rate went from 0.00 per 1000 device days for over 36 months to 1.37 per 1000 device days in the first six months of 2015.

In summary, the best evidence based practices to prevent HAIs infections can be negatively impacted by minor changes in the classification of cases at the National level.

REFERENCESCDC/HICPAC 2011 Guidelines for the prevention of intravascular related infections.

APIC 2007. Dispelling the Myths: The True Cost of Healthcare Associated Infections.

Ceballos K., Hulett, Makic MB. Nurse-Driven quality improvement interventions to reduce hospital-acquired infection in the NICU. Advance in Neonatal Care. Jun 2013; 13(3):154-63.

Jarvis WR. (2011) Healthcare Associated Infection Prevention Bundles: Preventing the Preventable. www.jasonandjarvis.com ;

Atlantic Quality Innovation Network Improving Healthcare for the Common Good®(IPRO). August 2015

National Healthcare Safety Network (NHSN). September 2015

CONTACT INFO

Dilci.Ortega@nychhc.orgChris.Charles@nychhc.orgGloria.Watson@nychhc.org

• List five components of the CLABSI prevention bundle.

• Discuss the financial impact of CLABSIs on the healthcare system.

• Define Standardized Infection Ratio (SIR) and Cumulative Attributable Difference (CAD)

Dilcia Ortega, RN, MSN/MPH, CIC; Chris Charles, RN, MHA, CIC; Gloria M. Watson, RN, PhDInfections (CLABSI) in an urban acute care facility

Figure 2: Facility Wide CLABSI SIR (July 2014 – June 2015)

Figure 3: CLABSI SIR for CMS/IPPS (Jan. 2014 – June 2015)

To achieve our goals of reducing CLABSI rate in Adult ICU and Non-ICU patients by 50% and achieving a 95% or greater compliance with use of CLABSI Prevention Bundle, we implemented several measures. To evaluate our progress, we used two statistical measures, the SIR and CAD. SIR is used to compare different patient populations (e.g. ICU vs Non-ICU patients). CAD is a measure of the number of infections that occurred compared to the number of infections that were predicted.

• Infection Control reviews all CLABSI cases with clinical teams

• Nurses are empowered to stop the insertion procedure if there is non compliance with guidelines

• Staff conducts daily inspection of site dressing and document their findings

• Compliance is monitored daily using a Central Line Dressing Form/Checklist

• Catheter hubs, needleless connectors, and injection ports are disinfected before accessing the catheter

• Educated staff in ‘best practice’ through monthly staff meetings

• Implemented the use of Central Line Bundle

Proper hand hygiene is performed before and after catheter insertion or manipulation

Maximal barrier precaution is employed Chlorhexidine is used for skin prepOptimal catheter insertion site selection

[avoid femoral vein – there is a greater likelihood of contamination]

Daily review of necessity of lines at multidisciplinary rounds and timely removal of lines.

Figure 4: CLABSI Bundle Compliance (Jan. 2014 – June 2015)