Reducing CLABSI and CAUTI: Does the Infection Preventionist's Title Matter?

Abstract

<h3>Background</h3> Central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) are associated with morbidity, mortality, expense and prolonged length of stay, yet these infections are largely preventable. We found that CLABSI/CAUTI reduction success varied widely within our 27-facility US acute care hospital system, and that infection prevention (IP) leadership roles were not standardized throughout. We conducted a 12-month study to examine differences in CLABSI and CAUTI standardized infection ratios (SIR) between director-led IP programs and manager-led programs. We also analyzed additional variables that may have influenced the outcomes between the two groups. <h3>Methods</h3> Nine of our facility IP programs are led by directors, while 18 are led by managers. CLABSI and CAUTI SIRs were calculated for each group via the National Healthcare Safety Network (NHSN). In addition, we examined IP years' experience, certification (CIC) status, and IP staffing ratios to account for differences in knowledge, experience, and full-time equivalents (FTE) available for the programs. An eight-question survey was sent to front-line nursing staff at each facility via Survey Monkey to assess nursing perceptions on the importance of the IP program. Analysis was completed on levels of influence using Fischer's Exact and Student's T Tests. <h3>Results</h3> Analysis revealed that programs led by IP directors had statistically significant lower CLABSI (p=0.00) and CAUTI (p=0.026) SIRs than manager-led programs. There was no significant difference in years of IP experience (p=0.31), CIC status (p=0.38) or the number of FTEs (p=0.24) between each group. Additionally, survey results on perceptions of IP program importance among front line nursing staff showed significantly higher scores for IP directors reporting to senior leadership (p=0.04). <h3>Conclusions</h3> Our study suggests that director-led IP programs may be more successful in CLABSI and CAUTI reductions due to the direct reporting structure and access to senior leadership that influences perception of the IP program.