Reduction in Central Line Associated Bloodstream Infections across a Long-Term Acute Care Hospital System

Abstract

BACKGROUND Long-term acute care hospitals (LTACHs) have faced challenges with central line associated bloodstream infections (CLABSIs). Central lines are common among patients in this setting, increasing risk for CLABSI. The goal of this research is to determine whether CLABSI reduction initiatives have resulted in a decrease in CLABSI infections. METHODS The LTACH system has 26 hospitals, geographically dispersed across the country. Since 2015, the healthcare system has implemented more consistent reviews of central line necessity, increased education for Infection Preventionists about identifying infections, standardized central line dressing kits, and more robust antimicrobial stewardship committees within each hospital. The hospitals utilize National Healthcare Safety Network to submit identified CLABSIs. CLABSI Standardized Infection Ratios (SIR) and central line Standardized Utilization Ratios (SUR) were reviewed at a system level from 2015 to 2018. RESULTS When comparing 2015 to September 2018, the system has had 145 fewer CLABSI infections identified, an estimated cost savings of $2,672,640. The SIR in 2015 was 1.57, whereas the SIR for 2018 is 1.18, a decrease of 39%. In 2015 the system had 106 more CLABSIs than predicted, whereas in 2018, the system has had 23 more than predicted. In 2018, the system used 63,252 fewer lines when compared to 2015. In 2015, the system used 47,000 more lines than expected, as compared to 9,936 more than expected in 2018. The SUR in 2015 was 1.38 and in 2018 the SUR was 1.10, which indicates a 28% reduction in central line usage. CONCLUSIONS Scrutiny and education on central line usage, in addition? to more education to IPs and standardized dressing change kits have results in significant decreases in infection identified throughout the LTACH system. While the system still has room for improvement in reducing CLABSI, standardization of processes has shown a decrease in CLABSIs and thus better quality care for patients.