Reducing Central Line Bloodstream and Catheter-Associated Urinary Tract Infections in the Neuro Critical Care Unit Using a Bundled Approach

Abstract

Central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) represent adverse outcomes for patients and healthcare organizations. Critically ill patients who experience neurological deficits are at increased risk of infection. In our neuro critical care unit (NCCU), baseline CLABSI and CAUTI rates were above institutional goals and national benchmarks, indicating an opportunity for improvement. NCCU leadership and staff created and implemented a bundled improvement plan to reduce the incidence of CLABSI and CAUTI in January, 2014. The bundle consisted of aseptic insertion and care and maintenance processes. Identification of a physician champion was also identified in the early stages and provided leadership for the multidisciplinary rounding process, including daily assessment of device necessity, line status, planning for device discontinuation. Specific unit based education was provided to all frontline clinical staff that included assessment of competency and education related to daily chlorhexidine bathing for all patients. In April, 2014, peri care with a chlorhexidine product was added to the indwelling urinary catheter care and maintenance bundle and external male catheters were more frequently utilized as an alternative to indwelling urinary catheters. Midline venous access devices were introduced as an alternative to central venous access devices when appropriate. Aseptic urine and blood specimen collection processes were reviewed with all care providers responsible for their collection. All identified CLABSI and CAUTI’s are reviewed in real time with frontline staff and healthcare providers. Data related to infection control is provided to NCCU leadership and staff monthly. Compared to infection rates reported in 2013, statistically significant reduction in CLABSI and CAUTI rates was achieved January to November, 2014. The CLABSI reduction was 100%, (p = 0.03); CAUTI reduction was 47% (p=0.04). Device utilization was significantly reduced for both indwelling urinary catheters and central venous access devices Iincluding PICCs. A bundled approach to prevention of device-associated infections can be successful in a NCCU when implemented by a multidisciplinary team that includes a physician champion.