Building a Culture of Patient Safety by Eliminating Central Line Associated Bloodstream Infections

BACKGROUND/OBJECTIVES: Hospital acquired infections can be eliminated with determination as opposed to resources. Hospital acquired infections are costing hospitals and society millions of dollars. Central line associated blood stream infections (CLABs) are most common in the intensive care unit (ICU) setting. Nationally, 80,000 CLABs occur in ICUs per year, with a mortality rate of 18%. One CLAB can add 14 days to a patientʹs length of stay and result in an additional $40,000 in costs. Hospitals routinely absorb the majority of costs incurred in the care of patients with CLABs. Evidence based patient care practices, called “bundles,” that have been designed to improve patient safety and reduce adverse patient outcomes such as CLABs are not being used consistently by healthcare organizations. METHODS: A multidisciplinary CLABs team was formed to prevent CLABs, CLABs related deaths and ensure implementation of a “Central Line Bundle” in all patients requiring a central line. Interventions included: physician and nurse reeducation and recertification on central line insertion and maintenance, standardization of practices to ensure maximal utilization of barrier precautions, skin prep with chlorhexidine and placement in the subclavian site. Practices were monitored by Nursing who were empowered to ask and stop persons who did not follow appropriate practices. A daily review of line necessity was done as well as a root cause analysis performed in real time for every CLAB. A central line insertion kit was developed to include all necessary barrier precaution, insertion and maintenance components. Data were reported back to end users on a regular basis. RESULTS: A significant reduction in CLABs was noted. Within 90 days, the ICU CLABs rate decreased from 8.5 to 0.0 per 1,000 line days. There have been no CLABs for over five months. Compliance with the “Central Line Bundle” increased from 70% to 100%. Hand hygiene compliance increased from 85% to 100%. Daily review of line necessity resulted in a 15% decrease in central line days. Costs avoided in the elimination of CLABs was nearly $500,000. CONCLUSIONS: CLABs were eliminated with limited additional resources. The use and monitoring of evidence based patient care practices or “bundles” with reporting back of data to end users resulted in the rapid and sustained elimination of CLABs. These efforts can easily be adapted for areas outside of the ICU where central lines are inserted.