Putting the Cap on Central Line–Acquired Bloodstream Infections

Abstract

Our quest for zero central line–acquired bloodstream infections (CLABSIs) began in the fall of 2017. Using the model for improvement from the Institute of Healthcare Improvement helped navigate our initial goal to reduce the CLABSI rate from 2/1,000 catheter days to 1/1,000 catheter days. This nurse-led CLABSI project was designed to address two key drivers: (a) Create a culture of accountability and safety and (b) increase communication, understanding, and use of the CLABSI insertion and maintenance bundles. Setting small, attainable goals stimulated staff nurses’ passions to achieve success. The NICU CLABSI quality improvement team included bedside nurses, the NICU nursing director, medical providers, and NICU peripherally inserted central catheter (PICC) team nurses. Interventions to decrease risk of CLABSI included adherence to standardized practices for central line care while systematically introducing standardized CLABSI insertion and maintenance bundles. Staff audits, readiness rounds, electronic medical record changes, and peer-to-peer audits ensured improved nursing knowledge of central lines. A data board aided in staff and family communication and created transparency of our quality improvement work. Data were collected in standardized format according to Centers for Disease Control and Prevention criteria and compared with historical NICU CLABSI rates. Our CLABSI rate decreased by 50% from September 2017 through August 2018. We are currently 345 days without a CLABSI in our NICU. Using key drivers, with each tied to multiple interventions and tested using plan–do–study–act cycles, made our work meaningful. The meticulous attention to CLABSI bundle processes and audits of each measure assured a reliable level of hardwiring changes; in addition, these interventions yielded a dramatic effect on nursing staff accountability. Our clinical standards focused on insertion as well as maintenance bundle elements, using highly reliable methods. Tools such as visual reminders of bundle elements, line-necessity discussions led by nurses, and daily nursing and multidisciplinary huddles to ensure nurse accountability consistently yielded greater than 95% reliability of implementation of each bundle element.