Central Line-associated Bloodstream Infections Events Research Articles

Iterative Health Equity Analyses of Central Line-Associated Bloodstream Infection (CLABSI) Events at a Pediatric Hospital

Background: Per the Centers for Disease Control and Prevention, health equity stipulates all have a fair, just opportunity to attain their highest level of health. Limited evidence exists for disparities in health equity and healthcare-associated infections (HAI), with no evidence on language or primary insurance payor. While reviewing quality metrics, a disparity signal in central line-associated bloodstream infections (CLABSIs) prompted a multidisciplinary deep dive, with iterative analyses to understand potential inequities to identify improvement opportunities. Methods: CLABSI data was stratified and analyzed for evidence of disparity by race/ethnicity, primary insurance payor, and preferred spoken language utilizing an internal methodology. Subsequent analyses included a root cause analysis (RCA), case mix index (CMI) analysis, analysis of CLABSI Kamishibai card (K-card) rounding to monitor maintenance bundle reliability, and comparison of distribution of central venous catheter (CVC) line days to K-card audits [Figure 1]. Chi-square tests were used to test for significant differences for categorical variables in RCA and K-card analyses. ANOVA was used to compare CMI between demographic groups. Multiple logistic regression was used to compare K-card compliance rates by demographic groups. Results: When stratifying CLABSI rate by primary payor, pairwise comparisons indicated patients with a public payor had a statistically higher rate of CLABSI compared to private (p=0.02) [Figure 2A]. RCA analysis revealed when compared to patients with private payors, those with public had significantly higher rates of overdue needless connector changes (p = 0.03) and increased number of daily CVC entries (p = 0.05), while patients speaking another language (p = 0.02) were significantly more likely to have CVC contamination events. CMI analyses on CLABSI cases did not show patient acuity to vary significantly between demographics. Bivariate analysis of K-card data revealed minor differences in reliability with 7 Core Maintenance Bundle Elements by demographics; adjusting for all demographics and accounting for unit, pairwise comparisons indicated public payors had significantly higher compliance than international [Figure 2B]. We found no major differences in demographic distribution of CVC line days compared to K-card audits, suggesting we representatively audit maintenance bundle process measures. Conclusions: Our review of health equity in CLABSI events ultimately led to subsequent questions requiring analysis of other data sets. Utilizing an exploratory approach and assembling a multidisciplinary team to identify potential drivers of identified disparities adds value to health equity analyses. This is the first description of HAI data beyond race and ethnicity and can assist other institutions in their process of evaluating healthcare disparities and HAIs.

Practices to prevent central line-associated bloodstream infection: A 2021 survey of infection preventionists in US hospitals.

To determine prevalence of technical and behavioral interventions aimed at preventing central line-associated bloodstream infection (CLABSI) following the COVID19 pandemic. Cross-sectional survey. US acute care hospitals. Infection preventionists at participating hospitals. Surveys were sent to infection preventionists from a national random sample of 881 US acute care hospitals. Questions covered use of technical interventions to prevent CLABSI (eg, alcohol-containing chlorhexidine gluconate [CHG] for skin antisepsis, use of coated catheters), socio-adaptive interventions (eg, feedback of CLABSI rates, use of appropriateness criteria), and leadership support for CLABSI prevention. Survey response rate was 47% (415/881). Technical interventions such as maximal sterile barriers (99%) or CHG-impregnated dressings (92%) were highly prevalent, but routine use of CHG bathing was less common (68% indicated regular use in intensive care unit [ICU] vs 18% in non-ICU settings). Although 97% of respondents indicated use of systems to monitor CLABSI, feedback to providers on CLABSI events was reported by 89%. Only 53% of respondents indicated regular use of tools to determine appropriateness of central venous catheters (CVC). Three-quarters of respondents indicated their hospital assessed CVC necessity daily, but only 23% reported strategies to reduce routine blood cultures. CLABSI prevention was extremely important to hospital leadership at 82% of responding hospitals. Most US hospitals continue to use evidence-based methods to prevent CLABSI as recommended by leading organizations. Opportunities to focus on socio-adaptive interventions such as feedback of infection rates, use of appropriateness criteria for CVC placement, and improving the "culture of pan-culturing" remain.

A Process Evaluation Approach to Central Line-Associated Bloodstream Infection Reduction in a Neonatal Population.

To reduce the rate of central line-associated bloodstream infections (CLABSI) in the M Health Fairview Neonatal Intensive Care Unit (NICU) from 2.15 infections per 1,000 central line days to less than one per 1,000 line days using process evaluation. An interdisciplinary team used process mapping and Failure Modes and Effects Analysis (FMEA) to identify root causes and improvement opportunities in central line maintenance. The focus was on neonates born at <32 weeks of gestational age and weighing less than 750 g. Interventions included standardized clean space, algorithms to reduce line access, and standardized kits for line maintenance. Over 4years, the project achieved an 86.6% reduction in CLABSI events, decreasing from 15 events in 2019 to two in 2023. The CLABSI rate dropped by 85%, from 2.15 to 0.32 per 1,000 line days. Statistical analysis indicated a significant reduction in FMEA risk scores for the identified failure modes, with an average reduction of 33%. The process-focused approach and interdisciplinary collaboration significantly reduced CLABSI rates in the NICU. Future efforts should aim to maintain these improvements and achieve a target of zero CLABSI events.

Reducing central line-associated bloodstream infections (CLABSI) by improved identification of primary infection sites through preliminary blood culture notifications.

Central line-associated bloodstream infections (CLABSI) pose a significant patient risk. To address incorrect classifications of infectious events as CLABSI, the surveillance process was changed from using finalized blood culture to preliminary blood culture results as trigger of timely, in-depth reviews. This improved the detection of true CLABSI events.

Reducing the rate of central line-associated bloodstream infections; a quality improvement project

BackgroundThe burden of central line-associated bloodstream infections is significant and has negative implications for healthcare, increasing morbidity and mortality risks, increasing inpatient hospital stays, and increasing the cost of hospitalization. Efforts to reduce the incidence of central line-associated bloodstream infections have utilized quality improvement projects that implement, measure, and monitor outcomes. However, variations in location, healthcare organization, patient risks, and practice gaps are key to the success of interventions and approaches. This study aims to evaluate interventions of a quality improvement project on the reduction of central line-associated bloodstream infection rates at a university teaching hospital.MethodsThis was a retrospective review of a quality improvement project that was implemented using the Plan-Do-Study-Act quality improvement cycle. Active surveillance of processes and outcomes was performed in the critical care areas; compliance to central line care bundles, and central line-associated bloodstream infections. Interrupted time series was used to analyze trends pre and post-intervention and regression modeling to estimate data segments preceding and succeeding the interventions.ResultsThere were 350 central line insertions, 3912 catheter days, and 20 central line-associated bloodstream infection events during the intervention period. Compliance with central line care bundles was at 94%. There was a trend in the reduction of central line-associated bloodstream infections by 18% that did not reach statistical significance (p = 0.252).ConclusionsImprovement projects to reduce central line-associated bloodstream infections face challenges and complexities associated with implementing interventions in real-world healthcare settings. There is a great need to continuously monitor, evaluate, readjust, and adapt interventions to achieve desired results, sustain improvements in patient outcomes, and investigate reasons for non-adherence as keys to achieving desired outcomes.

Implementation of Supportive Care Program to Decrease CLABSI in a Middle East Pediatric Hematology and Oncology Inpatient Unit.

Background: Central venous catheters (CVCs) support the administration of chemotherapy and other medications, blood products, fluids, and nutrient infusions, and reduce the need for peripheral blood sampling in children with cancer. CVC use is also associated with the risk of central-line-associated bloodstream infection (CLABSI). Despite the implementation of CLABSI care bundles, CLABSI prevention remains challenging. Method: This project implemented supportive preventive care interventions to decrease CLABSI in pediatric hematology/oncology patients in a tertiary hospital in the Middle East region. Interventions included bathing or skin care once daily, oral care twice daily, and ambulating patients three times daily. Parent and staff education materials were developed. The project moniker was Step 1-2-3, inspired by successful implementations of such measures in a U.S. cohort showing reduced CLABSI rates. The project used a mixed methods approach. We report outcomes through August 2022. Results: Pre-project (12/2019-05/2020) five CLABSIs occurred in the inpatient unit. Following the implementation of Step 1-2-3, Pediatric Oncology achieved 492 CLABSI-free days. Six CLABSIs then occurred over a short period of time between October 2021 and January 2022, which was associated with high levels of patient acuity and staff sick leave. The inpatient ward remained CLABSI-free from January 9, 2022, through August 2022. Discussion: Extended periods of CLABSI-free care in a pediatric hematology/oncology unit are achievable. A variety of factors contribute to the sustainability of being CLABSI-free. Data collection and analysis are important factors which aided in our understanding of our own CLABSI events.

Central Line Associated Bloodstream Infections in Critical Ill Patients during and before the COVID-19 Pandemic.

(1) Background: The purpose of this study was to evaluate the impact of the COVID-19 pandemic on the rates of central line-associated bloodstream infections (CLABSI), its etiology, and risk factors in critically ill patients, because Slovakia was one of the countries experiencing a high burden of COVID-19 infections, and hospitals faced greater challenges in preventing and managing CLABSI; (2) Methods: A retrospective analysis of CLABSI data from all patients admitted to adult respiratory intensive care units before and during COVID-19 pandemic was conducted. We followed the guidelines of the Center for Disease Control surveillance methodology for CLABSI. Data were analyzed using STATISTICA 13.1; (3) Results: We analyzed the data of 803 ICU patients hospitalized for 8385 bed days, with 7803 central line days. Forty-five CLABSI events were identified. The CLABSI rate significantly increased during the COVID-19 pandemic compared to before the COVID-19 pandemic (2.81 versus 7.47 events per 1000 central line days, (p < 0.001). The most frequently identified pathogens causing CLABSI were Gram-negative organisms (60.20%). The risk factors found to increase the probability of developing CLABSI were length of stay (OR = 1.080; 95% Cl: 1.057-1.103; p < 0.001) and COVID-19 (OR = 5.485; 95% Cl: 32.706-11.116; p < 0.001). (4) Conclusions: The COVID-19 pandemic was associated with increases in CLABSI in ICUs. These data underscore the need to increase efforts in providing surveillance of CLABSI and implementing infection prevention measures.

Epidemiology and preventability of hospital-onset bacteremia and fungemia in 2 hospitals in India.

Studies evaluating the incidence, source, and preventability of hospital-onset bacteremia and fungemia (HOB), defined as any positive blood culture obtained after 3 calendar days of hospital admission, are lacking in low- and middle-income countries (LMICs). All consecutive blood cultures performed for 6 months during 2020-2021 in 2 hospitals in India were reviewed to assess HOB and National Healthcare Safety Network (NHSN) reportable central-line-associated bloodstream infection (CLABSI) events. Medical records of a convenience sample of 300 consecutive HOB events were retrospectively reviewed to determine source and preventability. Univariate and multivariable logistic regression analyses were performed to identify factors associated with HOB preventability. Among 6,733 blood cultures obtained from 3,558 hospitalized patients, there were 409 and 59 unique HOB and NHSN-reportable CLABSI events, respectively. CLABSIs accounted for 59 (14%) of 409 HOB events. There was a moderate but non-significant correlation (r = 0.51; P = .070) between HOB and CLABSI rates. Among 300 reviewed HOB cases, CLABSIs were identified as source in only 38 (13%). Although 157 (52%) of all 300 HOB cases were potentially preventable, CLABSIs accounted for only 22 (14%) of these 157 preventable HOB events. In multivariable analysis, neutropenia, and sepsis as an indication for blood culture were associated with decreased odds of HOB preventability, whereas hospital stay ≥7 days and presence of a urinary catheter were associated with increased likelihood of preventability. HOB may have utility as a healthcare-associated infection metric in LMIC settings because it captures preventable bloodstream infections beyond NHSN-reportable CLABSIs.

An Analysis of Outcomes Following a Central Line Associated Blood Stream Infections (CLABSI) Reduction Quality Improvement Project in a Tertiary Care Center.

Central Line Associated Blood Stream Infections (CLABSI) continue to be a significant complication for hospitalized patients. Hospitals have used various strategies to reduce CLABSI events due to the significant complications and associated costs. In this QI analysis, we examined the impact of a CLABSI reduction quality improvement project within a single ICU at a tertiary care medical center. Absolute CLABSI counts were compared between this ICU and other health system ICUs that did not implement the bundle. A sustained reduction in absolute CLABSI counts to or near zero was observed over 17 months after implementation. ICUs not performing the interventions during this time consistently reported ≥ 2 CLABSI per month. Further analysis is needed to assess causality and the generalizability of bundle components to other ICUs. These findings may provide other health systems with additional strategies to prevent CLABSI and provide consistent, evidence-based supportive care to critically ill patients.

Quality Improvement Initiative in a Community Hospital to Reduce Central Line Device Utilization Rate.

Background The intensive care unit (ICU) in a community hospital insouthwest Minnesota saw a steady increase in central line-associated bloodstream infections (CLABSI)and an increase in the utilization of central lines. The baseline CLABSI rate was 11.36 at the start of the project, which was the highest in the last five years. The corresponding device utilization rate (DUR) was 64%, which increased from a pre-COVID pandemic rate of 45%. Aim The aim of this project was to decrease the ICU DUR by 37.5% from a baseline of 64% to 40% within six months without adversely impacting staff satisfaction. Methods A multidisciplinary team using the define, measure, analyze, improve, and control (DMAIC) methodology reviewed the potential causes of the increased use of central lines in the ICU. The team identified the following major causal themes: process, communication, education, and closed-loop feedback. Once the root causes were determined, suitable countermeasures were identified and implemented to address these barriers. These included reviewing current guidelines, enhanced care team rounding, staff education, and the creation of a vascular access indication algorithm. The team met biweekly to study the current state, determine the future state, evaluate feedback, and guide implementation. Results The pandemic saw a surge in the number of severely ill patients in the ICU, which may have caused an increase in the DUR. The project heightened the awareness of the increased DUR and its impact on the CLABSI rate. The initiation of discussion around this project led to an immediate decline in DUR via increased awareness and focus. As interventions were introduced and implemented, the DUR continued to decrease at a steady rate. Post implementation, the DUR met the project goal of less than 40%. The team continued to track progress and monitor feedback. The DUR continued to meet the goal for three months post implementation. Since the start of the project, there have been no CLABSI events reported. This effort has positively impacted safety and patient outcomes. Conclusions Through a defined process, the central line utilization rate in our ICU was decreased to 37.5% to meet the target goal and has been sustained.

Novel strategies to reduce central-line–associated blood stream infection (CLABSI) events in the neonatal intensive care unit

Background: We describe the components of an improved and easy-to-implement strategy to reduce CLABSI events in the NICU implemented during July–September 2021 in a tertiary-care healthcare center. These strategies were added to an existing institutional protocol created following CDC guidelines. Methods: During the previous timeframe of the implementation of new strategies, CDC insertion-related prevention measures [ie, hand hygiene, use of personal protective equipment (PPE), catheter size selection, standard chlorhexidine gluconate (CHG) antisepsis, maintenance related Curos disinfecting caps, and scrubbing the hub] were part of an existing protocol at our institution. We introduced the following key elements along with the previous ones: decrease length of umbilical vein catheter (UVC) utilization from 14 days to 5–7 days, change of dressing materials from BIOPATCH to 3M Tegaderm CHG chlorhexidine gluconate IV securement transparent dressing, enhanced compliance of an existing artificial nail policy, and restricted blood draw from central lines. Results: After optimization of the previous protocol through these additional strategies, we achieved a significant reduction in the NICU CLABSI rates from 12 CLABSI events between July 2020 and June 2021 to only 3 CLABSI events between July 2021 and June 2022. Conclusions: Revision of CLABSI bundle prevention protocols should be performed frequently to allow improvement opportunities to be added to diminish infection rates. The addition of simple and easy-to-implement key elements interventions to the existing CLABSI bundle had an important impact on the CLABSI rate at our institution.Disclosures: None

Evaluating racial disparities in central-line–associated bloodstream infections for Tennessee hospitals, 2018–2021

Background: Central-line–associated bloodstream infections (CLABSIs) significantly burden the US population and healthcare system. Reporting facilities in Tennessee consistently omit race and ethnicity data in the NHSN despite having the option to enter. Racial and ethnic disparities are well documented across many health outcomes, including patient safety. CLABSIs were compared among 3 racial groups to better understand the impact of race on CLABSI incidence in Tennessee. Methods: CLABSI data from NHSN were linked with records from the TN Hospital Discharge Data System (HDDS) for 2018–2021. A multivariable linear regression model was used to determine relative risk (RR) between racial groups for contracting a CLABSI after controlling for confounding variables including Charlson comorbidity index (CCI) and social vulnerability index (SVI) scores. Statistical significance was set at P &lt; .05. Data linkage and statistical analyses were performed in SAS version 9.4 software. Results: In Tennessee between 2018 and 2021, 342 (17.2%) of the 1,980 CLABSI events had race documented, and no ethnicity variables exist in the NHSN. The data linkage process yielded a 72% match (1,426 CLABSIs). The remaining 28% were excluded from the analysis. Per 1,000 central-line days (CL days) for all races, white patients had the highest CLABSI rate (17.5), followed by Black patients (1.36), and Native American or Alaskan Native patients (0.68). Per 1,000 admissions by race, Black patients had a higher CLABSI rate (1.26) than Native American/Alaskan Native patients (0.85) and white patients (0.75). The risk of contracting a CLABSI was 79% higher in Black patients than in white patients (RR, 1.79; 95% CI, 1.55–2.07; P &lt; .0001) when controlling for CCI, age group, and SVI. Conclusions: These results suggest that racial disparities between Black and white patients are present in Tennessee hospitals regarding CLABSIs. Although most CLABSI events were linked to HDDS patients, there were limitations in the ability to match all cases and calculate CL days by race. This study highlights the need for complete race and ethnicity data in the NHSN. Further studies should examine infection types at the regional and facility levels to target interventions for reducing HAI inequities in Tennessee.Disclosures: None

Factors affecting the Gut Microbiome in Pediatric Intestinal Failure.

There is little data on gut microbiome and various factors that lead to dysbiosis in pediatric intestinal failure (PIF). This study aimed to characterize gut microbiome in PIF and determine factors that may affect microbial composition in these patients. This is a single-center, prospective cohort study of children with PIF followed at our intestinal rehabilitation program. Stool samples were collected longitudinally at regular intervals over a one-year period. Medical records were reviewed, and demographic and clinical data were collected. Medication history including the use of acid blockers, scheduled prophylactic antibiotics and bile acid sequestrants, was obtained. Gut microbial diversity among patients was assessed and compared according to various host characteristics of interest. The final analysis included 74 specimens from 12 subjects. Scheduled prophylactic antibiotics, presence of central line associated bloodstream infection (CLABSI) at the time of specimen collection, use of acid blockers and ≥ 50% calories delivered via parenteral nutrition (PN) was associated with reduced alpha diversity, whereas increasing age was associated with improved alpha diversity at various microbial levels (p-value<0.05). Beta diversity differed with age, presence of CLABSI, use of scheduled antibiotics, acid blockers, percent calories via PN and presence of oral feeds at various microbial levels (p-value <0.05). Single taxon analysis identified several taxa at several microbial levels which were significantly associated with various host characteristics. Gut microbial diversity in PIF subjects is influenced by various factors involved in the rehabilitation process including medications, percent calories received parenterally, CLABSI events, the degree of oral feeding and age. Additional investigation performed across multiple centers is needed to further understand the impact of these findings on important clinical outcomes in PIF.

Central Line Associated Blood Stream Infection Reduction at an Academic Community Hospital During the COVID-19 Pandemic to Achieve Patient Safety

During the COVID-19 pandemic, many institutions saw an overall increase in central line associated blood stream infection (CLABSI) events. CLABSI events can be prevented by decreasing central line utilization, improving practices during central line insertion and maintenance phases, and daily surveillance for necessity. A belief that zero harm to patients is possible and development of a supportive organizational culture with visible leadership were key to reducing CLABSI events and creating long-lasting change, even during the pandemic.

Impact of COVID-19 pandemic on the rates of central line...associated bloodstream infection and catheter-associated urinary tract infection in an.ßintensive care setting:.ßNational experience

COVID-19 is believed to increase the risk of secondary healthcare-associated infections (HAIs). The objective was to estimate the impact of COVID-l9 pandemic on the rates of central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infections (CAUTI) in Ministry of Health (MOH) hospitals across Saudi Arabia. A retrospective analysis of prospectively collected CLABSI and CAUTI data over a period of three years (2019-2021) was done. The data was obtained from the Saudi Health Electronic Surveillance Network (HESN). All adult ICUs in 78 Ministry of Health hospitals that contributed CLABSI or CAUTI data before (2019) and during (2020-2021), the pandemic were included. During the study, 1440 CLABSI events and 1119 CAUTI events were identified. CLABSI rates significantly increased in 2020-2021 compared with 2019 (2.50 versus 2.16 per 1000 central line days, p=0.010). CAUTI rates significantly decreased in 2020-2021 compared with 2019 (0.96 versus 1.54 per 1000 urinary catheter days, p<0.001). COVID-19 pandemic was associated with increased CLABSI rates and reduced CAUTI rates. COVID-19 pandemic is believed to have negative impacts on several infection control practices and surveillance accuracy. The opposite impact of COVID-19 on CLABSI and CAUTI is probably reflecting the nature of case definition.

Reducing Central-Line-Associated Bloodstream Infections (CLABSI): An Improvement Project in a Specialized Tertiary Hospital.

Central-line-associated bloodstream infections (CLABSI) are preventable hospital-acquired infections that harm and prolong a patient's hospital stay and increase unnecessary hospital expenditure. In collaboration with infection control and hospital epidemiology, the quality management department initiated a performance improvement project to address 144 CLABSI events in 2017. The performance improvement project team used brainstorming to create change ideas presented in a driver diagram. The team then applied plan-do-study-act (PDSA) cycles to implement and monitor the improvements. Finally, the team applied a bundle of interventions that included the following: (a) policies and procedures for central line insertion, maintenance and removal processes standardization, (b) physicians training for line insertion by simulation, (c) an awareness campaign that included recognizing healthcare workers and enhancing patient engagement, (d) performing root cause analysis for the CLABSI events, and (e) automation of central line insertion, and (f) maintenance bundles documentation in the hospital information system. The CLABSI rate per 1000 patient days dropped from 1.5 per 1000 device days to 1.03 per 1000 device days. In addition, CLABSI events reduction was 24% by 2018. Then further reduction of 15% occurred by the end of 2019. Thus, the overall decrease in CLABSI events was 35% from the baseline number of events (i.e., 144 events) in 2017. Another achievement of the project is that 10 units reported zero CLABSI events in 2018 and 2019, of which four units had a high central line utilization rate, more than 40%. The implemented interventions effectively reduced the CLABSI events in the hospital. The project team will continue implementing more interventions with monitoring, aiming to achieve zero CLABSIs over time in all the hospital units.

Reduction of Central-line-Associated Bloodstream Infections in a Tertiary Neonatal Intensive Care Unit through Simulation Education.

Critically ill neonates and those with complex medical conditions frequently require the use of central venous lines. Unfortunately, central line-associated bloodstream infections (CLABSIs) result in significant morbidity and mortality, and the cost and increased length of stay burden the healthcare system. Previous studies have demonstrated that standardized care bundles can decrease CLABSI rates, but achieving sustained improvement has proven difficult. All patients admitted to the Neonatal Intensive Care Unit between 2014 and 2020 who had a CVL were included in this study. First, we recorded all CLABSI events and total CVL days according to defined criteria. Then, in late 2016, we instituted simulation-based nursing training for CVL care. Job Instruction Sheets were initially introduced to Neonatal Intensive Care Unit nursing staff simultaneously with one-on-one teaching sessions between instructors and bedside nurses. Intermittent performance audits and re-education for identified deficiencies did not improve the CLABSI rate per 1000 line days. After instituting simulation-based CVL training in 2016, there was a decreased rate of CLABSI events per 1000 line days sustained over time (x = 0.692). Standardized care bundles and Hospital-acquired Condition interactor audits were insufficient to reduce the CLABSI rate. However, combining care bundles and education with simulation-based training significantly decreased CLABSI rates. One-on-one intensive training and continued ongoing monitoring were critical to producing a sustained reduction. This experience demonstrates that supervised, interactive education combined with simulation can significantly impact patient outcomes.

Reducing central-line associated bloodstream infections (CLABSIs) through patient accountability contracts: A pilot project for patients on Weill Cornell Medicine (WCM) bone marrow transplant (BMT) service.

283 Background: Patients with cancer whom develop Central Line Associated Blood Stream Infections (CLABSIs) have increased mortality rates ranging from 12% to 40%. Transplant patients are particularly at risk due to cytotoxic chemotherapy regimens and/or graft-versus-host disease with risk for translocation of oral and gut flora to the bloodstream. At Weill Cornell Medicine, we had 102 CLABSIs in 2021, 25 (25%) of which attributed to patients in oncology units. The Bone Marrow Transplant (BMT) Unit, had 10 of the 25 (40%), 2.05 CLABSIs per 1000 central line inpatient days with a CLABSI standardized infection ratio (SIR) of 1.26 (above goal of 1). Methods: Our SMART aim was to reduce the number and rate of CLABSI events on the BMT unit by 10% from February 1, 2022 – June 30, 2022 by educating patients on preventive strategies and implementing a patient central-line maintenance “contract.” We had previously optimized evidence-based nursing interventions for CLABSI prevention which included adherence to central line maintenance best practices, weekly device rounds with Infection, Protection &amp; Control to monitor compliance with dressing changes and IV tubing, annual CLABSI prevention competencies, peer-to-peer validation of blood culture lab draws, weekly quality-improvement huddles and interdisciplinary root cause analysis discussions for CLABSI events. Patient noncompliance with daily recommendations for central line care was identified as a possible CLABSI risk factor that was not previously addressed in the bundle. Newly-developed patient education and a “contract” was incorporated into the BMT admission process. Results: The BMT CLABSI patient education and contract was initiated with all new patients admitted to unit in February 1, 2022. Since starting, the BMT unit CLABSI SIR has decreased from 1.26 to 0.6, and from a CLABSI rate per 1000 central lines days of 2.05 to 0.97. Conclusions: Engaging patients in their own care of the central lines can significantly reduce overall risk of central line infections. Patients have positively responded to this pilot project. We have translated educational materials and contracts to other languages and are considering expansion into other units.

Selective National Healthcare Safety Network Central Line-Associated Bloodstream Infection Validation in State Health Department, Jan – June 2018

Background Accurate reporting to the National Healthcare Safety Network (NHSN) is critical in providing actionable surveillance data to inform infection prevention (IP) programs. The state health department (SHD) validated Central Line-Associated Bloodstream Infections (CLABSI) to assess data accuracy and identify common reporting errors. Methods Utilizing the NHSN external validation toolkit, the SHD validated 21 facilities based on data reported from Intensive Care Units (ICU) and Medical, Surgical, and Medical/Surgical Ward locations during January to June 2018. Nine facilities were selected for both ICU and Ward locations, 6 for ICU only and 6 for Ward only. For each facility, up to 20 reported NHSN CLABSI events and up to 40 unreported or candidate events were reviewed. Patient medical records were reviewed to determine if the selected blood culture met CLABSI event criteria. Results The SHD reviewed a total of 1112 medical records. The SHD identified 120 reportable CLABSI events; of these, 7/120 (6%) were reported with errors and 10/120 (8%) were not reported at all. Additionally, the SHD found two reported events that were deemed Secondary Bloodstream Infections (BSI); therefore, did not meet primary CLABSI criteria and were subsequently over-reported. The overall sensitivity was 92% and specificity was 99.8%. Facility specific sensitivities ranged from 71% to 100%. Conclusions The majority of unreported CLABSI events were due to misattribution of the event as a Secondary BSI. In these instances, along with the over-reported events, facilities most often incorrectly applied the site-specific criteria for pneumonia. Of the seven events that were reported incorrectly, the most common reporting errors were incorrect location due to the transfer rule and incorrect event date, specifically when the symptom occurred before the culture date when applying Laboratory-Confirmed Bloodstream Infection (LCBI) criteria 2. The SHD will use these results to tailor NHSN training and education to facilities. Accurate reporting to the National Healthcare Safety Network (NHSN) is critical in providing actionable surveillance data to inform infection prevention (IP) programs. The state health department (SHD) validated Central Line-Associated Bloodstream Infections (CLABSI) to assess data accuracy and identify common reporting errors. Utilizing the NHSN external validation toolkit, the SHD validated 21 facilities based on data reported from Intensive Care Units (ICU) and Medical, Surgical, and Medical/Surgical Ward locations during January to June 2018. Nine facilities were selected for both ICU and Ward locations, 6 for ICU only and 6 for Ward only. For each facility, up to 20 reported NHSN CLABSI events and up to 40 unreported or candidate events were reviewed. Patient medical records were reviewed to determine if the selected blood culture met CLABSI event criteria. The SHD reviewed a total of 1112 medical records. The SHD identified 120 reportable CLABSI events; of these, 7/120 (6%) were reported with errors and 10/120 (8%) were not reported at all. Additionally, the SHD found two reported events that were deemed Secondary Bloodstream Infections (BSI); therefore, did not meet primary CLABSI criteria and were subsequently over-reported. The overall sensitivity was 92% and specificity was 99.8%. Facility specific sensitivities ranged from 71% to 100%. The majority of unreported CLABSI events were due to misattribution of the event as a Secondary BSI. In these instances, along with the over-reported events, facilities most often incorrectly applied the site-specific criteria for pneumonia. Of the seven events that were reported incorrectly, the most common reporting errors were incorrect location due to the transfer rule and incorrect event date, specifically when the symptom occurred before the culture date when applying Laboratory-Confirmed Bloodstream Infection (LCBI) criteria 2. The SHD will use these results to tailor NHSN training and education to facilities.

A Recipe for Success: Conducting a Gap Analysis to Decrease Central Line-associated Bloodstream Infection (CLABSI) Rates in a Post-COVID-19 World

BackgroundDuring the 2020 COVID-19 pandemic hospitals nationwide saw significant increases in central line-associated bloodstream infections (CLABSIs). Factors that likely influenced this include staffing challenges, personal protective equipment practices and drift in compliance with infection prevention bundles. To prevent further infections in 2021, a 788-bed teaching hospital established a multidisciplinary team to conduct a gap analysis to identify practice drifts that may have resulted due to the COVID-19 pandemic and develop targeted interventions.MethodsA team composed of infection prevention, nursing, physicians, and environmental services conducted a gap analysis that included re-evaluation of policies, procedures, and infection prevention bundles in conjunction with a frontline staff survey of current practices to assess for practice drift. Inconsistent use of a central line insertion checklist and nursing maintenance handoff tool and lack of frontline staff participation in a CLABSI committee were identified and targeted for modification & re-implementation in January 2021. To assess intervention effectiveness 2020 pre-implementation CLABSI rate and standardized infection ratio (SIR) (January – December) were compared to 2021 post-implementation CLABSI rate (January -September) and SIR using the exact binomial test and mid-p 95% confidence.ResultsDuring the pre-implementation period, there were 34 CLABSIs with a rate 0.745 CLABSIs per 1,000 central-line days and an SIR of 0.691. After implementation, 18 CLABSIs occurred with rate of 0.494 per 1,000 central-line days and SIR of 0.463. While not statistically significant this represented a 47.0% decrease in CLABSI events, a 33.7% decrease in rate (IDR p-value: 0.1583) and 33.0% decrease in SIR (two-tailed p-value: 0.1679, 95% Conf. Interval: 0.371 – 1.178) between the two periods.ConclusionsMultidisciplinary gap analysis identified practice drifts in use of evidence-based tools during the COVID-19 pandemic. Re-implementation of these modified tools and improved participation in the CLABSI committee lead to an approximate 33% reduction in CLABSI rate and SIR.