CLABSI Prevention - Using a 90 Day Sprint

Abstract

Background Most projects have longer timelines than we expect, but approaching a large project using a 90-day sprint approach can work when applied in the correct setting. Central line associated bloodstream infections (CLABSI) increased significantly across our eight-hospital healthcare system, beginning late in fourth quarter 2019 and extending through mid-year 2020. The twelve-month rolling system standardized infection ratio (SIR) increased significantly from 0.634 to 1.074. Using a 90-day sprint plan, numerous best practices were identified as key opportunities for CLABSI prevention and two main focus areas were identified for intervention: 1) daily chlorhexidine gluconate (CHG) bathing for all patients with central lines and 2) daily line necessity evaluation. Methods The first 30 days we 1) developed an electronic daily process measure report for CHG bathing and daily line necessity evaluation using the electronic medical record (EMR) and emailed this report every morning to all hospital leadership and 2) created training materials based on reliable evidence based practices in the two focus areas for CLABSI prevention. The next 60 days were educating and driving these focus areas within each unit at each of the hospitals. Results Over the 60 days of rolling out the daily process measure report we saw tremendous improvement in both focus areas: daily CHG bathing is averaging around 80% compliance and performing daily line necessity is averaging around 70%. Also, since the implementation of our focused CLABSI work we have reduced our total number of central line day duration from an average line day of 11.4 days to 4.6 days. Conclusions Using a 90-day sprint approach and limiting the focus to only two distinct and measurable areas we have seen an increase in compliance with both focus areas that have also led to a reduction in central line days which all help reduce the risk of CLABSI.