A Patient Safety Initiative To Reduce Central-Line Associated Bacteremias

BACKGROUND/OBJECTIVES: Central-line associated bacteremias (CLABs) are associated with increased morbidity, mortality and costs to hospitals. Our goal was to decrease our CLAB rate by half, from an average of 5.4 per 1000 devices over the past five years and to possibly eliminate CLABs in the MICU. METHODS: A multidisciplinary team, including nurses, physicians and infection control practitioners was assembled. The team designed a central-line kit to include all items necessary for the procedure, including the catheter, drapes, barriers and chlorhexadine 2% antiseptic skin prep. A central-line insertion checklist was developed to monitor all elements of central-line insertion. Additional efforts included educating staff; empowering the nurses to stop any procedure when the checklist criteria was not met; daily assessment of the central-line and encouragement of staff to remove all femoral lines as soon as possible. The team evaluated every positive blood culture and a root cause analysis was performed. Collection and analysis of data was done according to CDC guidelines from the National Healthcare Safety Network (NHSN) program. Improvements of tools and forms used and communication with other departments to address issues continued to evolve as the initiative progressed. RESULTS: From July through December 2005, the average number of CLABs in the MICU over the previous 5 surveillance periods decreased from 6 to 3, a 50% reduction. The CLAB rate decreased from 5.4 per 1000 device days (6 infections/1232 device days) averaged over five years to 2.2 per 1000 device days (3 infections/1343 device days) in 2005. The CLAB rate for the prior year decreased from 6.5 (9 infections/1373 device days), to 2.2, resulting in a 66% reduction. These results were in spite of a high utilization ratio of 0.82 (1343 device days/1629 patient days). CONCLUSIONS: Implementing a program to standardize best practice methods to decrease CLABs with sustained vigilance has resulted in a significant reduction of these infections in the Medical ICU over six months. Using recent estimates, this CLAB initiative may have saved between $40,000 and $172,000 and reduced the length of stay by 42 days. Future goals include improved staff education, greater involvement on the leadership level and a full ICU rollout progressing to hospital-wide implementation.