Beyond Bundles: Justification for a Central Venous Catheter (CVC) Care Team Program for the Prevention of Bloodstream Infections

Abstract

ISSUE: The BSI rate for our Neurotrauma intensive care unit (NTICU) for the first quarter of 2004 was 8.8 bloodstream infections (BSI)/1000 line days (near the NNIS 90 th percentile of 9). Initial efforts focused on implementation of the IHI “BSI bundle” (hand hygiene, appropriate site selection, chlorhexidine use, aseptic technique, maximum barriers, and prompt line removal). Nevertheless, the lack of significant impact precipitated an administrative query regarding programs to control these infections more efficiently. PROJECT: A CVC care team program was piloted by instituting a “dedicated CVC care nurse.” This nurse was assigned to assist in all line insertions and perform all line care (twice weekly). She had a proactive role in keeping track of line days and the condition of the CVC's, and advising physicians when sites looked infected. She investigated line infections as they occurred and provided real time feedback to the unit. The CVC care nurse worked the morning shift on weekdays. RESULTS: The rate of infections decreased from 8.8 BSIs/1000 line days during the first quarter of 2004 to 6.5-6.9 BSIs/1000 line days during the 2 nd and 3 rd quarters when the BSI bundle was in place. Implementation of the CVC care team pilot program on the 4 th quarter decreased the rate to 4.3 BSI/1000 line days. As seen in the table, using expected and actual infections, as well as literature and cost estimates from our own hospital, we calculated that the CVC care team project has the potential to avoid between $20,000 to $315,000 in excess healthcare costs per ICU per quarter. LESSONS LEARNED: Implementing the BSI bundle only decreased the infection rate by approximately 25%, with multiple sustainability issues. The CVC care team program decreased the infection rate by approximately 50%, having potentially less sustainability issues due to total control of the process, assuring compliance with the BSI bundle. Having unit staff (physicians, PA's, nurses, etc.) buy-in of the program was essential. Cost avoidance estimates easily justify the full implementation of a comprehensive line team program. Financial Savings Period Rate/1000 line days Interventions Infections avoided Conservative savings @ $4,000/BSI Average savings @ $40,000/BSI Aggressive savings @ $63,000/BSI 1Q04 8.8 Baseline Baseline Baseline Baseline Baseline 2Q04 6.5 BSI bundle 3 $12,000 $120,000 $189,000 3Q04 6.9 BSI bundle 2 $8,000 $80,000 $126,000 4Q04 4.3 CVC care team 5 $20,000 $200,000 $315,000