34 Achieving and sustaining zero CLABSI events in oncology patients by implementing targeted interventions

Abstract

Background Central line–associated bloodstream infections (CLABSIs) are one of the potentially life-threatening complications that occur in patients with cancer. Central lines are usually required in these patients for prolonged durations. The purpose of this study was to identify and implement multiple interventions for the prevention of CLABSIs in patients with cancer. Methods A multidisciplinary taskforce was created to identify and implement evidence-based interventions to achieve a target of zero CLABSI in both adult and pediatric oncology patients. Monitoring of CLABSI and central line bundle also continued as it was being done before creation of the taskforce. These interventions included mandatory educational sessions, use of a dedicated trolley for central line use only, patient and family education on care of central lines, chlorhexidine bath before insertion of central lines, review of staff competency on handling central lines, and improvement in the completion of central line bundle. These interventions were introduced at three levels of line management: pre-insertion, during insertion, and post-insertion of central lines. Data were collected on a daily basis with analysis and reporting on a quarterly basis. Results In adult patients, the quarterly rate of CLABSI in the four quarters of 2017 was 1.9, 1.9, 1.3, and 2.1 per 1000 central line days, respectively. The overall annual rate in the year 2017 was 1.8 per 1000 central line days with a total of seven CLABSI events and 3875 central line days. For pediatric patients, the quarterly rate of CLABSI in the four quarters of 2017 was 1.3, 1.2, 1.2, and 1.1 per 1000 central line days, respectively. The overall annual rate in the year 2017 was 1.2 per 1000 central line days with a total of eight CLABSI events and 6638 central line days. As a result of the interventions, no CLABSI events were observed in either adult or pediatric patients in the first two quarters of 2018. Conclusion A collaborative effort by the dedicated multidisciplinary team resulted in achieving zero CLABSI. The targeted interventions resulted in achieving the ultimate goal of zero CLABSI and sustaining it for 6 months in high-risk oncology patients.