Reduction Of Central Line-associated Bloodstream Infections Research Articles

Use of dry dressings for central venous access devices (CVADs) to decrease central line-associated blood stream infections (CLABSI) in a trauma intensive care unit (ICU).

In the 12 months following the change in practice, we noted a CLABSI reduction from 2.36/1,000 catheter days to zero, improvement in dressing audits from 19.61% to 85.34% of clean dressings (P=0.00001) and 62.75% to 90.58% of adherent dressings. Conclusion: In this pre-post study, a simple change in dressing type was implemented, resulting in a significant reduction in the CLABSI rate.

Is it cost effective to use a 2% chlorhexidine wipes bath to reduce central-line associated blood stream infection? A quasi-experimental study

BackgroundBathing with 2% chlorhexidine (CHG) wipes is an important measure regarding infection prevention in critically ill patients. The aim of this study was to evaluate the impact of CHG wipes bath to prevent central-line associated bloodstream infection (CLABSI) in critically ill patients and determine if such measure is cost-saving. Methodsa quasi-experimental study, conducted from July 2017 to April 2019. Daily bath with 2% CHG was used in all patients at the unit in the intervention period. The following were evaluated: CLABSI incidence density in both periods, 30- day mortality, guided antimicrobials used to treat CLABSI and 2% CHG costs. ResultsCLABSI incidence density dropped from 8.69 to 1.83 per 1.000 central line-days (p = 0.001), mainly by Klebsiella pneumoniae Carbapenen Resistant (Kp-KPC) (p = 0.05). Costs with guided antimicrobials for the treatment in pre-intervention were US$ 46,114.36, and in the intervention period, US$ 4,177.50. The 2% CHG monthly cost was US$ 2,698.00, achieving 30% savings when comparing both periods. DiscussionAn expressive reduction of 79% in CLABSI incidence density was observed, mainly due to Kp-KPC infection and also a reduction in guided antimicrobial costs. ConclusionsBathing with 2% CHG led to evident CLABSI reduction.

Zero bloodstream infection in medical wards: Achievable?

Background: Nosocomial bloodstream infection (BSI) was a significant problem at medical wards Hospital Sungai Buloh, majority of which were central-line associated BSI (CLABSI). Central venous catheter (CVC) care was suboptimal. Although CLABSI prevention program in ICU is proven to be effective, it is less well studied in non-ICU settings. Hence, we embarked a project to achieve zero BSI in three busy medical wards at Hospital Sungai Buloh, a tertiary hospital. Methods and materials: A multimodal CLABSI risk reduction strategy was employed, using the 4 ‘E’ approach (Engage, Educate, Execute, Evaluate). The medical wards’ matrons, sisters and infection control link nurse (ICLN) were engaged to “champion” the BSI reduction program. Education was given to doctors and nurses, focusing on three key behaviours, which were: (1) insert CVC only when indicated; (2) take care of CVC properly; (3) remove CVC as soon as not needed. In addition, education sessions with ICLN were held to ensure they could identify BSI cases correctly based on CDC definitions. Education posters and visual cues were placed at strategic locations. CVC care bundle form was implemented. Prospective surveillance, which consist of monitoring process measure (compliance to CVC care bundle) and outcome measure (BSI rate), was done. These results were then feedback to the stakeholders on monthly basis. The study was divided into pre-intervention (January–May 2019), intervention (June and July 2019), and post-intervention periods (August and September 2019). Results: During the pre-intervention period, the rates of nosocomial BSI and CLABSI were average to be 6.4 cases/month and 3.4 cases/month respectively. During intervention period, the average rates were 8 cases/month and 4.5 cases/month respectively. After intervention, both rates reduced significantly to average 1 case/month (87.5% reduction in nosocomial BSI, and 77.8% reduction in CLABSI). In fact, we achieved zero CLABSI in August 2019. This corresponded with improved CVC care compliance from average 46% during intervention period to 83% compliance rate post-intervention. Conclusion: Zero BSI, even in non-ICU settings, is achievable via multimodal strategy. Currently, we are continuing our program to ensure sustainability in reduction of BSI rates.

The Efficacy of Passive Valve Antimicrobial Swab Caps Against Existing Clabsi Prevention Bundle in an Adult Hematology Inpatient Population: A Quality Improvement Initiative

Background : Central line associated blood stream infections (CLABSI) have been the costliest of all healthcare associated infections. The average CLABSI cost is approximately $46,000 (Haddadin & Regunath, 2019). Most cases may be preventable with utilization of aseptic techniques, surveillance, and management through local protocols. The majority of CLABSI occur more than five days after central vascular access (CVA); therefore, there has been a growing focus on central line handling and maintenance techniques. CLABSI prevention data has been largely focused on the intensive care unit (ICU) patient population where an average of about half of patients have CVA. There have been few studies exploring the rates of CLABSI in the adult hematology population, a population with unique risk factors due to their immunosuppressing treatments and prolonged immunocompromised states. There has been emerging data that suggests the use of new technology in addition to existing central line maintenance recommendations by the Center for Disease Control may further reduce the rate of CLABSI occurrences in high-risk patient populations. Aim: To determine the efficacy of passive valve antimicrobial swab caps on the reduction of CLABSI in an inpatient hematology patient population when compared to current existing local practices. Outcomes of reported incidents of CLABSI have been evaluated against pre-interventional data for this setting. Methods : Retrospective analysis of medical records from January 2016 - September 2019 identified the existing rate of CLABSI occurrence among inpatient hematology patients at a single institution. We utilized the intervention of antimicrobial swab caps for 10 months and tracked the rate of CLABSI during this time. The nursing staff were educated on the quality improvement project, the use of the new equipment, and expectations that existing standard practices per local policy for CLABSI prevention bundles would be adhered to prior to the start of the intervention. To evaluate the impact of the antimicrobial swab caps on the rate of CLABSI we compared the number of infections pre- and post-intervention. Randomized audits, including chart reviews for compliance with existing standard CLABSI bundle practices were performed during the initial 3 months of the intervention. Results : Prior to the introduction of the passive valve antimicrobial swab cap to the existing CLABSI prevention protocol, CLABSI rates on the hematology unit exceeded the standardized infection ratio 75th percentile on 9 of the previous 15 calendar quarters. The intervention was observed for 6,674 central line days. The CLABSI rate during the intervention was 0.4495 per 1,000 central line days. The CLABSIs identified were due to nosocomial opportunistic infection in setting of immunosuppressed status (66%) and gastrointestinal translocation (33%). The common diagnosis in setting of CLABSI was refractory/relapse diffuse large B-cell lymphoma (66%) and active acute myeloid leukemia (33%). The two patients who were diagnosed with CLABSI were neutropenic with an absolute neutrophil count of 0 at time of CLABSI diagnosis. The organisms identified at time of CLABSI diagnosis were Clostridium ramosom, Enterococcus faecium, Staphylococcus epidermisis, and Candida parapsilosis. When considering the cost of a CLABSI to be about $46,000 per event and the annual cost for the inpatient hematology unit's use of the caps of approximately $19,710, the implementation of the antimicrobial swab cap reduced the cost associated with CLASBI in the hematology unit by approximately $26,290 annually. Conclusions : The introduction of the passive valve antimicrobial swab caps appears to demonstrate potential for reduced costs due to CLABSI when implemented into current CLABSI prevention bundles. This resulted in a 25% reduction in rates of CLABSI in the adult hematology patient population when compared to the previous year. The prevention of CLABSI in hematology patients with central vascular access remains challenging, however, standardized protocols for CLABSI prevention and use of antimicrobial swab caps may help further reduce the rate of CLABSI in hematology patients. Disclosures: No relevant conflicts of interest to declare. Disclosures Glennie: Pharmacyclics: Speakers Bureau; Janssen: Speakers Bureau. Bensinger:BMS: Consultancy, Honoraria, Research Funding, Speakers Bureau; Sanofi: Consultancy, Honoraria, Research Funding, Speakers Bureau; Janssen: Consultancy, Honoraria, Research Funding, Speakers Bureau; Amgen: Consultancy, Honoraria, Research Funding, Speakers Bureau; GSK: Consultancy, Honoraria, Research Funding, Speakers Bureau; Regeneron: Consultancy, Honoraria, Research Funding, Speakers Bureau. Patel:Celgene/BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Speakers Bureau; AstraZeneca: Consultancy, Research Funding, Speakers Bureau; BeiGene: Consultancy; Adaptive Biotechnologies: Consultancy; Genentech: Consultancy, Speakers Bureau; Kite: Consultancy; Pharmacyclics: Consultancy, Speakers Bureau.

Quality Improvement to Reduce Neonatal CLABSI: The Journey to Zero.

Neonatal infections, including those associated with central lines, continue to be a major cause of morbidity and mortality despite many other improvements in neonatal outcomes. Over the past decades, significant advances have been made to reduce central line-associated bloodstream infections (CLABSIs) using quality improvement methodology. This article will review pertinent studies that used both the Institute for Healthcare Improvement Model for Improvement and other innovative techniques such as orchestrated testing and health care failure mode and effects analysis. These studies, by applying best practices, have demonstrated substantial and sustainable reductions in CLABSI. Some initiatives have been able to achieve rates of zero CLABSI for prolonged periods of time. While neonates often require prolonged central venous access and suffer from impaired immunity which increases the risk of CLABSI, this review demonstrates the journey to zero is feasible. KEY POINTS: · Quality improvement methods are effective to reduce CLABSI.. · Improvement strategies vary by setting.. · Achieving zero CLABSI rates is possible..

Sustained reduction of healthcare-associated infections after the introduction of a bundle for prevention of ventilator-associated pneumonia in medical-surgical intensive care units

BackgroundInfection control interventions can be erroneously interpreted if outcomes are assessed in short periods. Also, statistical methods usually applied to compare outcomes before and after interventions are not appropriate for analyzing time series. AimsTo analyze the impact of a bundle directed at reducing the incidence of ventilator-associated pneumonia (VAP) and other device-associated infections in two medical-surgical intensive care units (ICU) in Brazil. MethodsOur study had a quasi-experimental design. Interrupted time series analyses (ITS) was performed assessing monthly rates of overall healthcare-associated infections (HCAI), VAP, laboratory-confirmed central line associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI), from January 2007 through June 2019. Moreover, multivariate ITS was adjusted for seasonality in Poisson regression models. An intervention based on a bundle for VAP prevention was introduced in August 2010. FindingsThe intervention was followed by sustained reduction in overall HCAI, VAP and CLABSI in both ICU. Continuous post-intervention trends towards reduction were detected for overall HCAI and VAP. ConclusionInterventions aimed at preventing one specific site of infection may have sustained impact on other HCAI, which can be documented using time series analyses.

Impact of Continuous Education and Training in Reduction of Central Line-associated Bloodstream Infection in Neurointensive Care Unit.

ABSTRACTBackgroundPatients in the neurointensive care unit have high utilization of devices, thereby increased chance of getting device-associated infection (DAI). Central line-associated bloodstream infection (CLABSI) remains one of the most important DAI. Education remains an important part of the hospital infection control and improves the infection-control practices.Materials and methodsTo evaluate the effectiveness of a quality initiative in reducing incidence of CLABSI, a prospective study (January 2017–December 2018) was done estimating CLABSI incidence before and after the intervention. Continuous teaching and training for hand hygiene practice and central-line catheter hub care were used as the tool for this study.ResultsThe quality improvement (QI) initiative achieved a 48% reduction in the CLABSI rate from the baseline rate of 8.7 to 4.5 per 1000 catheter days. The overall mortality showed a reduction from 1.5 to 0.05% during the post-intervention period. There was a significant improvement in compliance with the hand hygiene practice and catheter hub care in the post-intervention period.Discussion and conclusionThis study demonstrates adherence to hand hygiene and catheter hub care with continuous teaching, training, and supervision was highly effective in reducing the CLABSI rate.Clinical significanceCentral line-associated bloodstream infection is one of the most important DAI causing significant morbidity and mortality in critically ill patient. Our findings support that continuous educational intervention of hand hygiene with and training on the catheter hub care are two most important preventive measures in the reduction of CLABSI incidence.How to cite this articleMohapatra S, Kapil A, Suri A, Pandia MP, Bhatia R, Borkar S, et al. Impact of Continuous Education and Training in Reduction of Central Line-associated Bloodstream Infection in Neurointensive Care Unit. Indian J Crit Care Med 2020;24(6):414–417.

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

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.

Reducing Central Line Associated Blood Stream Infections in a Major Academic Facility Using a Novel Comprehensive Tool

<h3>Background</h3> Central line-associated blood stream infections (CLABSIs) are a major source of morbidity, mortality, and increase in cost for healthcare facilities. At our facility, a multi-disciplinary team created a comprehensive tool to prevent higher than expected number of CLABSIs. <h3>Methods</h3> This quality improvement project was conducted at a 953 bed- Level 1 Trauma Teaching Facility, in the 105- bed adult intensive care units (ICUs). On August 2017, a novel comprehensive tool to reduce CLABSI was created by a multi-disciplinary team. The tool was implemented in January 2018. A multidisciplinary team (nurses, vascular access team, physicians, infection prevention), collaborated on CLABSI prevention. The first step was performing Apparent Cause Analysis (ACA) for CLABSI cases. The ACA identified the following improvement opportunities: Device indication, insertion bundle completion, device access, dressing best practices, daily audits, necessity for central lines in patients leaving ICUs, prompt removal of emergent lines (femoral), standardized line insertion and dressing kits, Chlorhexidine Gluconate (CHG) daily bathing, timely identification of CLABSI and posting unit specific CLABSI run charts, and patient education. ACA findings were remediated with staff education (flyers, just-in-time), and the Kamishibai CLABSI maintenance Audit Tool (K card). <h3>Results</h3> Statistically significant reduction in the number of CLABSIs was reported in 2019 (P-value 0.003). In 2016 and 2017, the ICUs reported a Standard Infection Ratio (SIR) of 2. In 2018 and 2019 up to September, the ICUs reported a SIR of 1 and 0.9 respectively. The observed CLABSI reduction was >50% with a decrease from 42 in 2016, to 34 in 2017, to22 in 2018 and 13 in 2019. <h3>Conclusions</h3> Utilizing ACA, involving front-line staff and leadership, providing just-in-time education to targeted staff, continuing education, and ensuring the appropriate audit tools (K card) are in place, enhances staff awareness, resulting in a significant reduction in CLABSI rates.

Impact of a hospital-wide huddle on device utilisation and infection rates: a community hospital's journey to zero.

Device utilisation ratios (DUR) correlate with device-associated complications and rates of infection. We implemented a hospital-wide Daily Interdisciplinary Safety Huddle (DISH) with infection control and device components. The aim of this study was to evaluate the impact of DISH on DURs and rates of infection for indwelling urinary catheters (IUC) and central venous catheters (CVC). A quasi-experimental study assessing DURs and rates of infection before and after implementation of DISH. At DISH, usage of IUC and CVC is reported by managers and the infection preventionist reviews indications and plans for removal. Data before and after implementation were compared. Paired T-test was used to assess for differences between both groups. DISH was successfully implemented at a community hospital. The average DUR for IUC in intensive care unit (ICU) and non-ICU settings was reduced from 0.56 to 0.35 and 0.27 to 0.12, respectively. CVC DUR decreased from 0.29 to 0.26 in the ICU and 0.14 to 0.12 in non-ICU settings. Catheter-associated urinary tract infections (CAUTIs) decreased by 87% and central line-associated bloodstream infections (CLABSIs) by 96%. DISH was associated with hospital-wide reductions in DUR and device-associated healthcare-associated infections. Reduction of CLABSIs and CAUTIs had estimated cost savings of $688,050. The impact was more profound in non-ICU settings. To our knowledge, an infection prevention hospital-wide safety huddle has not been reported in the literature. DISH increased device removal, accountability and promoted a culture of safety.

CE Article: Nursing-Placed Midline Catheters and Ultrasound-Guided Peripheral IVs Promote More Appropriate Catheter SelectionCE

Highlights Abstract Purpose: Deep vein thrombosis (DVT) and central line-associated bloodstream infection (CLABSI) are serious complications of peripherally inserted central catheters (PICCs). Because of these risks, midline catheters (MCs) and ultrasound-guided peripheral intravenous catheters (USGPIVs) were added to the capabilities of the host institution’s nursing-based venous access team (VAT), which operates under the direction of Interventional Radiology (IR). This report evaluates this effort to reduce PICCs and MCs through appropriate patient-centered device choice. Materials: A retrospective analysis of PICCs, MCs, and USGPIVs placed in inpatients in a large tertiary care academic hospital was conducted, using the VAT’s record supplemented with data from the IR quality assurance database. Analysis of hospital records of upper extremity DVT and CLABSI was also performed. Results: The VAT documented 33,113 PICC, 12,135 MC, and 14,300 USGPIV placements from September 2001 to March 2018. From the peak of PICC placements in 2006 to the peak of MCs in 2010, PICCs decreased 23% (P &amp;lt; 0.01), while MCs increased 93% (P &amp;lt; 0.001). Following full implementation of USGPIV in January 2016, MCs decreased 34% from 2015 to 2016 (P &amp;lt; 0.01) with no concurrent decrease in PICCs (P = 0.72). CLABSI rates per 1000 central venous catheter days decreased from 1.5 to 0.44 (P &amp;lt; 0.01), coinciding with an unrelated CLABSI reduction initiative. No interpretable trends in DVT counts were discovered. Conclusions: Appropriate use of MCs and USGPIVs by an IR-supported VAT significantly decreased PICCs and MCs, respectively.

Two Person Dressing Change Team to Prevent Central Line-Associated Bloodstream Infections (CLABSI) in a Stem Cell Transplant Unit at a Tertiary Medical Center

<h3>Topic Significance & Study Purpose/Background/Rationale</h3> Stem Cell Transplant (SCT) patients are at high risk for Central Line Bloodstream Infections (CLABSI). These infections may result in extended length of stay, increased cost, CMS penalty, and death. Care and maintenance of Central Venous Lines (CVL) is an oncology nursing practice. In 2017 SCT unit nursing staff acknowledged concern for unit CLABSI rate along with reports of practice variation. Literature, guidelines, and best practice were collected. Through collaboration with institution healthcare professionals these nurses identified a potential practice change. The purpose was to evaluate if implementation of a 2 person (CVL) dressing change team would reduce CLABSIs on the SCT unit of a tertiary medical center. <h3>Methods, Intervention, & Analysis</h3> We selected the Iowa Model Revised- Evidence Based Practice to Promote Excellence in Health Care© along with the Quality Improvement Model, DMAIC, to guide our change process. Four nurses were trained and worked to standardize workflow and maintain sterility throughout the CVL dressing change. In addition, a supply cart and standardized day were established. All patients with a CVL on the SCT unit were included. The outcome, CLABSI rate, was conducted utilizing the National Healthcare Safety Network (NHSN) CLABSI manual, internal focused reviews, and observations of care and maintenance of the CVL by Nursing Practice Leaders and an Infection Preventionist. <h3>Findings & Interpretation</h3> Implementation of a 2 person (CVL) dressing change team led to a 78.3% non-MBI CLABSI reduction on the SCT unit of a tertiary medical center 1 year following implementation. This standardized personnel/workflow/day of the week procedure also improved central line stewardship by patients. These findings are novel to the literature. Implications of these results have led this team to disseminate their work with other areas of the institution and share externally. <h3>Discussion & Implications</h3> Pivotal to the success of the 2 person dressing change team was continued focus on CLABSI prevention bundle by other healthcare team members. It is recognized that variations to workflow may need adjusted to fit needs. Continued investment to the CLABSI prevention bundle and standardized workflow is beneficial to the SCT nursing practice.

Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates

BackgroundPreventing central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) remains challenging in intensive care units (ICUs).ObjectiveThe Agency for Healthcare Research and Quality Safety Program for ICUs aimed...

Reduction of Central Line-associated Bloodstream Infection Through Focus on the Mesosystem: Standardization, Data, and Accountability.

Efforts to reduce central line-associated bloodstream infection (CLABSI) rates require strong microsystems for success. However, variation in practices across units leads to challenges in ensuring accountability. We redesigned the organization's mesosystem to provide oversight and alignment of microsystem efforts and ensure accountability in the context of the macrosystem. We implemented an A3 framework to achieve reductions in CLABSI through adherence to known evidence-based bundles. We conducted this CLABSI reduction improvement initiative at a 395-bed freestanding, academic, university-affiliated children's hospital. A mesosystem-focused A3 emphasized bundle adherence through 3 key drivers (1) practice standardization, (2) data transparency, and (3) accountability. We evaluated the impact of this intervention on CLABSI rates during the pre-intervention (01/15-09/17) and post-intervention (07/18-06/19) periods using a Poisson model controlling for baseline trends. Our quarterly CLABSI rates during the pre-intervention period ranged from 1.0 to 2.3 CLABSIs per 1,000 central line-days. With the mesosystem in place, CLABSI rates ranged from 0.4 to 0.7 per 1,000 central line days during the post-intervention period. Adjusting for secular trends, we observed a statistically significant decrease in the post versus pre-intervention CLABSI rate of 71%. Our hospital-wide CLABSI rate declined for the first time in many years after the redesign of the mesosystem and a focus on practice standardization, data transparency, and accountability. Our approach highlights the importance of alignment across unit-level microsystems to ensure high-fidelity implementation of practice standards throughout the healthcare-delivery system.

1169. Preventing Central Line-Associated Bloodstream Infections in Long-Term Acute Care

BackgroundLong-term acute care hospitals (LTACHs) care for chronically, critically ill patients with high utilization of central lines and high risk for morbidity from central line-associated bloodstream infections (CLABSIs). Our 38-bed LTACH noted a substantial increase in the incidence of CLABSIs (as defined by the National Healthcare Safety Network) between fiscal year (FY) 2016 and FY 2018 (Figure 1). Detailed case review identified a large number of CLABSIs which were clinically consistent with blood culture contaminants from central lines. Feedback from bedside staff also suggested gaps between practice and evidence-based measures for central line care.MethodsA three-pronged CLABSI prevention project was implemented in July 2018 consisting of (1) staff education regarding daily chlorhexidine (CHG) bathing for all patients, combined with an electronic audit report to identify patients without active CHG orders; (2) change in practice to the use of venipuncture alone for blood culture collection, combined with an electronic audit report to identify blood cultures collected from central lines; and (3) a recurring 6-part educational series for nurses focused on central line care. The pre-intervention period was defined as the 12-month period between July 1, 2017 and June 30, 2018 (FY 2018). The primary outcome was the fiscal year CLABSI rate. A secondary outcome was the proportion of blood cultures drawn from central lines.ResultsAfter 9 months of the intervention, one CLABSI had been reported for FY 2019 year-to-date at a rate of 0.4 per 1,000 CL-days, representing an 86% decrease from the FY 2018 rate of 2.8 per 1,000 CL-days. The 12-month rolling CLABSI rate decreased to 1.6 per 1,000 CL-days (Figure 2). The proportion of blood cultures collected from central lines decreased from 10.5% (69/658) to 4.5% (15/334), representing a 57% reduction. The proportion of patients ordered and receiving CHG bathing in the intervention period was >95%.ConclusionA multidisciplinary effort focused on CHG bathing, central line care, and blood culture collection led to a substantial reduction in CLABSIs in our LTACH. The use of electronic audit reports was particularly useful in achieving high adherence to practice changes. Disclosures All authors: No reported disclosures.

A comprehensive vascular access service can reduce catheter-associated bloodstream infections and promote the appropriate use of vascular access devices

This study describes the role of a novel vascular access service in the reduction and prevention of central line-associated bloodstream infections (CLABSIs). We conducted a retrospective analysis of data obtained over a span of 24 months after implementation of our vascular access service. We identified a progressive decline in the CLABSI rate and standardized infection ratio (SIR) in 2017 (rate, 1.75; SIR, 1.25) and in 2018 (rate, 1.037; SIR, 0.91). The reduction in CLABSIs was attributed to appropriate triage, insertion, and maintenance of vascular access devices.

The Centers for Disease Control and Prevention STRIVE Initiative: Construction of a National Program to Reduce Health Care-Associated Infections at the Local Level.

The Centers for Disease Control and Prevention STRIVE Initiative: Construction of a National Program to Reduce Health Care-Associated Infections at the Local Level.

'Adiós Bacteriemias': a multi-country quality improvement collaborative project to reduce the incidence of CLABSI in Latin American ICUs.

The incidence of central line-associated bloodstream infections (CLABSI) in Latin America has been estimated at 4.9 episodes per 1000 central line (CL) days, compared to a pooled incidence of 0.9 in the United States. CLABSI usually result from not adhering to standardized health procedures and can be prevented using evidence-based practices. The first phase of the 'Adiós Bacteriemias' Collaborative was implemented in 39 intensive care units (ICUs) from Latin America from September 2012 to September 2013 with a 56% overall reduction in the incidence of CLABSI. Bundles of care for the processes of insertion and maintenance of CLs have proven to be effective in the reduction of CLABSI across different settings. Building on the results of the first phase, we implemented a second phase of the 'Adiós Bacteriemias' Collaborative between June 2014-July 2015. We adapted the Breakthrough Series (BTS) Collaborative model to guide the adoption of bundles of care for CLABSI prevention through virtual learning sessions and continuous feedback. Eighty-three ICUs from five Latin American countries actively reported process and outcome measures. The overall reduction in the CLABSI incidence rate was 22% (incidence rate 0.78; 95% CI 0.65, 0.95), from 2.58 episodes per 1000 CL days at baseline to 2.02 episodes per 1000 CL days (P < 0.01) during the intervention period. Adiós Bacteriemias was effective in reducing the incidence of CLABSI and improving the adherence to good practices for CL insertion and maintenance processes in participating ICUs in Latin America.

Utilizing a Business Case to Link Reduction in Infections to Reduction in?Costs

BACKGROUND A review of literature indicates that expanding chlorhexidine gluconate (CHG) bathing beyond those at high risk to all patients can reduce hospital-acquired infection (HAI) rates. However, infection prevention strategies are often viewed as soft costs and difficult to fund despite HAI prevention being associated with significant cost avoidance. METHODS In February 2017 a task force was assembled to assess risk mitigation. A return on investment (ROI) was compiled for leadership highlighting the potential cost benefit of decreasing Central Line Associated Bloodstream Infections (CLABSI), Catheter Associated Urinary Tract Infections (CAUTI), Methicillin-Resistant Staphylococcus aureus (MRSA) bacteremia and Clostridium Difficile HAIs by expanding CHG use. We calculated the total cost of HAIs from 2016, including Centers for Medicare and Medicaid Hospital Acquired Condition Reduction Program (CMS HACRP) penalty (fiscal year 2017) [100% attribution to HAIs], direct cost and cost impact of HAI reduction using CHG bathing in current high risk populations and projected reductions and cost savings based on literature reviews and applied to all patients house-wide. On April 4, 2017 house-wide CHG bathing for all patients was implemented. Intensive staff education was provided with both face-to-face and electronic educational sessions with reinforcement at the annual employee quality fair. Compliance was measured by routine audits (chart reviews, unit rounds and staff feedback). RESULTS House-wide CHG bathing realized a CLABSI reduction of 65%. With a $17,445 direct cost per CLABSI, our total cost impact of reduction for this HAI was $226,785. Other infection decreases attributed to CHG bathing ranged from 28%-30%, raising the cost impact of HAI reduction to $439,803. CHG bathing costs totaled $40,114.10. CONCLUSIONS Identifying and quantifying the costs and benefits attributable to reduced HAIs at the facility level allows Infection Preventionists to present a business case necessary to justify program initiatives and drive improvement.

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

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.