Prevention of Central Line Associated Bloodstream Infections by Implementation of Central Line Bundle

Abstract

femoral sites for extended periods of time. We recognized the need to address more than line placement to prevent BSI. We looked at NACHRI's multicenter PICU project progress in BSI prevention through standardizing line care and maintenance (LCM). When our Medical Center's Infection Prevention and Control (IPC) Department organized a team to customize an intravascular (IV) LCM bundle, key PICU nursing personnel joined the effort. A customized IV LCM bundle based on CDC and INS bloodstream infection (BSI) prevention guidellines was developed by the hospital's Zero BSI team. Mandating education of CL insertion and LCM bundles in the PICU was not enough. When the hospital committed to participating in the national Stop BSI project, the PICU volunteered and a multidisciplinary unit-based team was organized to eliminate CLABSI. Patient safety became part of the unit culture. Unit champions were identified and empowered. Medical and nursing staff were engaged. A daily patient goal sheet was put into practice. Line care audits were started. Days and then months since the unit's last CLABSI were counted. Results: This multidisciplinary project resulted in nearly 97% reduction in CLABSI with a mean rate of 0.2/1,000 CL days from November 2009 to November 2011 while decreasing the number of CL days. Using SHEA's published estimates that each CLABSI has an 18% fatality rate, costs $36,000 to treat, and increases length of stay an average of 13 days, we calculated an expected number of CLABSI. Based on our baseline rate, the PICU's CLABSI prevention program has saved an estimated 3 or 4 lives, $756,000 in patient charges, and 273 days of unnecessary hospitalization. Lesson Learned: We learned that CLABSI prevention requires a standardized continuous multidisciplinary effort. It involves creating a culture of safety. Frequent monitoring and regular reports of bundle audits and infection rates to maintain staff interest and engagement are needed. Active participation and visible involvement of the IPC Department in the process is important. Administrative support is essential. All of these have helped our PICU change what is possible in CLABSI prevention.