Sustained Reduction of CLABSI in the LTAC (Long Term Acute Care) Setting with the Application of Two Strategies

Abstract

Background LTAC, is a part of the continuum of care that is not very well known as it covers a very specific group of patients with are acutely ill, many with comorbidities, but require a long term hospitalization. Our facility has struggled to keep CLABSI (Central Line Associated Blood Stream Infection) rates low due to very sick population of its patients. Over the years a collaborative approach with a multidisciplinary team has helped to lower our CLABSI rate. Methods Our hospital is 68-bed LTAC specializing in ventilator-dependent patients with an average length of stay of 39 days. The study design was a quasi-experimental look at the entire population over a three year period from January 2016-October 2019. In September of 2016 we added a gel impregnated patch to our central line dressing. Our rates remained low, however we could not achieve a sustained rate of zero so we added the addition of a scrub the hub product of 3.15% CHG (Chlorahexadine Gluconate) and 70% isopropyl alcohol in April of 2018. This product decreased the scrub time from 15 seconds scrub to a 5 second scrub. Results In the 12 month period after the introduction of the impregnated dressing, we realized a 51% reduction in CLABSI rate. In April 2018 introduction of CHG/70% alcohol for NC (needleless connector) hub disinfection resulted in a zero CLABSI rate that was sustained through May of 2019. Conclusions Several of the interventions when added to the bundle did seem to have an impact. These included the addition of the CHG-impregnated dressing for the central line, as well as the addition of the CHG/ alcohol pad for scrubbing the hub. Since April of 2018 our rates have gone down to zero and have been sustained. LTAC, is a part of the continuum of care that is not very well known as it covers a very specific group of patients with are acutely ill, many with comorbidities, but require a long term hospitalization. Our facility has struggled to keep CLABSI (Central Line Associated Blood Stream Infection) rates low due to very sick population of its patients. Over the years a collaborative approach with a multidisciplinary team has helped to lower our CLABSI rate. Our hospital is 68-bed LTAC specializing in ventilator-dependent patients with an average length of stay of 39 days. The study design was a quasi-experimental look at the entire population over a three year period from January 2016-October 2019. In September of 2016 we added a gel impregnated patch to our central line dressing. Our rates remained low, however we could not achieve a sustained rate of zero so we added the addition of a scrub the hub product of 3.15% CHG (Chlorahexadine Gluconate) and 70% isopropyl alcohol in April of 2018. This product decreased the scrub time from 15 seconds scrub to a 5 second scrub. In the 12 month period after the introduction of the impregnated dressing, we realized a 51% reduction in CLABSI rate. In April 2018 introduction of CHG/70% alcohol for NC (needleless connector) hub disinfection resulted in a zero CLABSI rate that was sustained through May of 2019. Several of the interventions when added to the bundle did seem to have an impact. These included the addition of the CHG-impregnated dressing for the central line, as well as the addition of the CHG/ alcohol pad for scrubbing the hub. Since April of 2018 our rates have gone down to zero and have been sustained.