QIM19-146: A Multidisciplinary Approach to Conquer Central-Line Associated Blood Stream Infections: Establishing the Continuum of Prevention

Abstract

Background: Central line associated blood stream infection (CLABSI) rates have been above the benchmark for our academic medical center that includes a comprehensive cancer center. In response, a 20% CLABSI reduction rate was set by the hospital Chief Medical and Associate Chief Nursing Officers. A multidisciplinary group convened to standardize central line insertion and maintenance practices. Product review showed 20 different central line insertion kits and 6 different dressing kits throughout the system. Hospital central line policy focused solely on nursing practice and there was not a policy including provider practice regarding central line insertion. A gap analysis determined dressing and insertion site integrity was compromised in 53% of our patients, including visible blood under 38% of the dressings, with oncology patients having some of our highest rates of bleeding. Objective: The purpose of this quality improvement project was to collaborate amongst disciplines to review practice, products, and policy for central line insertion and maintenance. We aimed to systematically improve practice across the central line continuum of prevention. Methods: A multidisciplinary team evaluated and defined current and best practice for policy and product changes. Implementation of best practice checklists included a team checklist to be used during insertion of every central line in the intensive care units and checklists that detailed practice steps in accordance with the updated central line policy. Central line dressing change prototypes were designed, products were compared, and approval for a standardized kit to support practice occurred. A new antimicrobial and hemostatic dressing was selected for line care to improve site integrity. The number of central line insertion kits was reduce by half and dressing kits were reduced to just one standard kit for the hospital system. Results: CLABSI rates have decreased from 7.43 cases/month to 3.6 cases/month following. Trends post-product rollout and repeat gap analysis data will be included at time of presentation. Conclusion: Reduction of CLABSI requires a multidisciplinary approach focusing simultaneously on best practices for central line insertion and maintenance. Best evidence for provider and nursing practice needs to be bundled in a comprehensive policy with checklist and products to support the standardization. Clinician evaluation and input on choosing products is critical to positive patient outcomes.