An organization-wide approach to decreasing central venous catheter bloodstream infections: Applying lessons learned from intensive care surveillance to general patient care units

Abstract

BACKGROUND/OBJECTIVES: NNIS data collection and analysis methodologies are utilized in our intensive care units (ICUs). Information from surveillance activities is used to improve patient outcomes. This has led to decreased rates of central venous catheter (CVC) bloodstream infections (BSIs). However, while rates of BSI have declined in the ICU, rates in non-ICU settings have risen. Our objective was to assess differences in line insertion and care between ICU and non-ICU settings, utilizing lessons learned to create an organization-wide approach to prevention of CVC BSIs. METHODS: The project was initiated in 2003.We conducted a gap analysis to measure differences between the insertion and care of CVCs and CDC-recommended guidelines. We also sought to understand differences in CVC care between ICU and non-ICU settings. The following issues were identified in the non-ICU setting: • Lack of trained personnel to care for lines • No clear denominator data • Inconsistent use of chlorohexidine for insertion • Lack of provider feedback • Problems with dressing integrity. We devised a data collection tool to capture line days on the general care units. Baseline rate of CVC BSIs was 8.0 per 1000 line days. We initiated actions based on our ICU successes and adapted some interventions specific to the non-ICU setting. These included: • Routine feedback to providers • Intensive education on accessing central lines • Chlorohexidine placed in all CVC insertion kits • Working with nursing to develop a protocol requiring dedicated staff to “troubleshoot” clotted or non-functioning lines • Advocating for dedicated staff for CVCs and obtaining administrative approval for the IV team to assume responsibility for care of CVCs in all non-ICU settings. RESULTS: In 2002, there were 119 CVC BSIs in 17,224 line days (rate of 6.9 per 1000 line days). Attributable mortality was 3.4%. In 2003, there were 62 CVC BSIs in 16,093 line days (rate of 3.9 per 1000 line days). Attributable mortality was 0 (zero). This reduction was statistically significant (p = 0.0002). Cost avoidance was estimated at $408,000–$1,685,000. Improvement efforts have been sustained. The 2004 rate of CVC BSIs was 1.5 per 1000 line days. CONCLUSIONS: Strategies adapted from specialty units can serve as a catalyst for organizational programs. Feedback, implementing recommended guidelines, and adapting effective strategies to new situations are essential components.