Reduction Of Central Line-associated Bloodstream Infections Research Articles

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.

Investigating potential drivers of increased central-line–associated bloodstream infections during the SARS-CoV-2 omicron-variant surge

Background: Central-line–associated bloodstream infection (CLABSI) rates increased nationally during COVID-19, the drivers of which are still being characterized in the literature. CLABSI rates doubled during the SARS-CoV-2 omicron-variant surge at our rural academic medical center. We sought to identify potential drivers of CLABSIs by comparing period- and patient-specific characteristics of this COVID-19 surge to a historical control period. Methods: We defined the study period as the time of highest COVID-19 burden at our hospital (July 2021–June 2022) and the control period as the previous 2 years (July 2019–June 2021). We compared NHSN CLABSI standardized infection ratios (SIRs), central-line standardized utilization ratios (SURs), completion of practice evaluation tools (PETs) for monitoring of central-line bundle compliance, and proportions of traveling nurses. We performed chart reviews to determine patient-specific characteristics of NHSN CLABSIs during these periods, including demographics, comorbidities, central-line characteristics and care, and microbiology. Results: The CLABSI SIR was significantly higher during the study period than the control period (0.89 vs 0.52; P = .03); the SUR was significantly higher during the study period (1.08 vs 1.02; P < .01); the PET completion per 100 central-line days was significantly lower during the study period (23.0 vs 31.5; P < .01); and the proportion of traveling nurses was significantly higher during the study period (0.20 vs 0.08; P < .01) (Fig. 1). Patients with NHSN CLABSIs during the study period were more likely to have a history of COVID-19 (27% vs 3%; P = .01) and were more likely to receive a higher level of care (60% vs 27%; P = .02). During the study period, more patients had multilumen catheters (87% vs 61%; P = .04). The type of catheter, catheter care (ie, dressing changes and chlorhexidine bathing), catheter duration before CLABSI, and associated microbiology were similar between the study and control periods (Table 1). Conclusions: During the SARS-CoV-2 omicron-variant surge, the increase in CLABSIs at our hospital was significantly associated with increased central-line utilization, decreased PET completion, and increased proportion of traveling nurses. Critical illness and multilumen catheters were significant patient-specific factors that differed between CLABSIs from the study and control periods. We did not observe differences in catheter type, duration, or catheter care. Our study highlights key modifiable risk factors for CLABSI reduction. These findings may be surrogates for other difficult-to-measure challenges related to the culture of safety during a global pandemic, such as staff education related to infection prevention and daily review of central-line necessity.Disclosures: None

Identifying risk factors for pediatric central-line–associated bloodstream infections

Background: Pediatric patients often require central venous catheters (CVCs) for a variety of clinical indications, including medication administration, parenteral nutrition, and venous blood sampling. Patients with CVCs are at risk for central-line–associated bloodstream infections (CLABSI). These hospital-acquired infections are often preventable and may lead to increased morbidity and mortality. Clinicians at a 477-bed, freestanding pediatric academic hospital completed a quality improvement project to identify factors that place pediatric patients at increased risk for CLABSI and to outline strategies aimed at CLABSI reduction for our highest-risk patients. Methods: Project leaders completed a literature review to evaluate current research on the topic and then assembled a project team. The team completed a retrospective analysis and categorization of CLABSI cases and reviewed internal CLABSI root-cause analysis data. The group then completed a case–control analysis to identify risk factors in patients with CVCs who developed CLABSIs, compared to patients with CVCs who did not develop CLABSI. Following this analysis, the team created a CLABSI risk-factor tool for use by bedside nurses. This tool described patients with CLABSI risk factors and outlined best practices for CLABSI prevention. Results: Based upon literature review, root-cause analysis data, and retrospective CLABSI case review over the period from 2017 to 2021, an initial list of 9 potential CLABSI risk factors was compiled. A case–control analysis was performed comparing 97 CLABSI cases with 103 matched controls. Univariate, multivariate, and additional covariate analyses were employed to identify 3 factors placing pediatric patients at increased risk for CLABSI. These included (1) multiple enteral devices (ie, 2 or more devices, including gastrostomy tube, jejunostomy tube, gastrostomy or jejunostomy tube, ostomy, and peritoneal drain); (2) multiple CVC entries (ie, CVC used for medications and venous sampling); and (3) long-term CVC plus parenteral nutrition (CVC in place for >21 days and receiving parenteral nutrition and/or intralipids). Conclusions: Pediatric patients with central venous access are vulnerable to CLABSI, and certain patients may be at increased risk. Frontline clinicians may be able to identify these patients and adopt best practices to prevent infection. A tool for use by bedside nurses can be a useful adjunct to existing CLABSI prevention practices.Disclosures: None

The Central HAC Team: Advancing the Culture of Safety Through Practice Observations.

Background: At SickKids, central line-associated blood stream infections (CLABSIs) remain one of the most prevalent hospital acquired conditions. Despite implementation of evidence-based prevention bundles, adherence remains a challenge and obtaining reliable bundle adherence data is complex. An innovative approach to address gaps in practice was developed. Objectives: A centralized hospital acquired conditions team consisting of nurse leaders was created to improve bundle adherence and data reliability. The team partners with local leadership to reinforce the CLABSI maintenance bundle organization wide. The team completes observations, provides just-in-time feedback to nurses, and obtains reliable bundle adherence data. Methods: The team developed a defined model to complete observations: identify, coordinate, observe, feedback, document, and collaborate. Feedback is provided using error prevention strategies. Observations are electronically documented and visualized in real-time to trend results. The team identifies data-driven opportunities to inform priorities. Results: Since September 2018, the team has completed nearly 1500 practice observations with an observed 45% CLABSI reduction and a statistically significant centerline shift (Fig. 1). To evaluate team effectiveness, 118 nurses completed a survey. Seventy-eight percent of respondents agreed feedback was clear and 59% felt it helped improve their practice. Bundle adherence data comparing the team to local unit observers remains variable; however, education of local champions is improving reliability. Conclusions/Implications: The centralized approach for providing just-in-time feedback is an effective method to promote evidence-based practice and drive CLABSI maintenance bundle adherence. This method improves understanding of common failure modes to target improvements. Preliminary evaluation highlights how the team impacts safety culture and improves patient outcomes through practice observations.Fig. 1.: The Hospital for Sick Children Statistical Process Control Chart displaying hospital CLABSI rate comparative to the Solutions for Patient Safety network from August 2018 to February 2022. CLABSIs = central line-associated blood stream infections.

Reducing CLABSI by Increasing Frequency of Incubator Changes.

Background: Babies born younger than 28 weeks, extremely low gestational age newborns (ELGAN), require central access for nutrition and medications, but their fragile skin and weak immune system increase risk for central line-associated blood stream infections (CLABSIs). CLABSI increases mortality, poor growth, poor neurodevelopmental outcomes, and longer hospital stays. After implementation of a CLABSI prevention team, overall CLABSI rates decreased but persisted in the ELGAN population. Pseudomonas was the predominant organism cultured, which prompted a focus on potential environmental causes. Objective: Current practice was to change incubators every 30 days or as needed for all patients. Infants on high-frequency ventilation were often excluded. ELGAN can require several weeks of high-frequency ventilation, increasing time spent in the same incubator. With a goal to decrease CLABSI in this population, we proposed that increased frequency of incubator changes would improve environmental cleanliness. Incubators were changed every 14 days. Methods: Using quality improvement methodology of plan-do-study-act cycles, incubator changes occurred in one patient at a time. The team huddled to plan each patient move, assign roles, and then evaluate success. Through plan-do-study-act cycles, changes were made to enable the patient to stay on the ventilator, and a checklist was developed to ensure stable vital signs and temperature. Results: Our unit had over 300 days without a CLABSI. We also had no safety events, hypothermia, or unplanned extubations during the trials. Our overall CLABSI rate reduced from 0.33 infections per 1000 line days to 0.29. Incubator changes at 14 days are now established as standard of care for the ELGAN population. Conclusions: Implementing frequent incubator changes contributed to a reduction of CLABSI by 13%. Preliminary data suggest that more frequent bed changes contribute to a reduction in other types of infections, including invasive pseudomonas. Next steps are to evaluate changing incubators every 2 weeks in all neonatal patients.

CLABSI Reduction Strategy: Utilizing Weekly Rounds with an Interdisciplinary Team.

Introduction: Central line-associated bloodstream infections (CLABSIs) in pediatric ICU patients lead to a wide variety of adverse outcomes, including increased mortality and morbidity, longer length of stay in the hospital, and greater healthcare costs.1 Pediatric cardiac ICU patients are at a significantly higher risk for these healthcare-associated infections because of an increase in risk factors, such as congenital anomalies, presence of surgical wounds, compromised immune function post cardiopulmonary bypass, and the presence of multiple invasive medical devices.2 After noting an increase in the pediatric cardiac ICU CLABSI rate, an interdisciplinary team was formed to approach the problem. Objectives: The primary aim was to decrease the pediatric cardiac ICU’s CLABSI rate by 25% in 8 months by engaging an interdisciplinary team with identifying and addressing CLABSI maintenance bundle concerns in real time on the unit. Methods: An interdisciplinary team with representatives from nursing, unit leadership, intensive care physicians, infection prevention, nurse practitioners, vascular access team, and quality improvement utilized initial Plan-Do-Study-Act (PDSA) cycles to develop a rounding tool that identified threats to the CLABSI prevention bundle with patient-specific interventions to consider implementing. Weekly interdisciplinary rounds were then conducted on all central lines. Additional PDSA cycles focused on addressing unit-specific gaps in education and increasing awareness of best practices for central line care and maintenance. These included addition and delineation of space to separate clean and dirty supplies, hygiene supplementations to the care bundle, eRecord handoff updates, and both in-person and online educational offerings. Results: Preliminary data suggested a decrease in CLABSI rate during the initial 4-month intervention period (Fig. 1). The focus on central line care has also led to more consistent and robust observations for bundle compliance. In 2021, zero CLABSIs were noted for the initial 4 months after intervention contributing to a unit record of 243 days CLABSI-free. We would like to call attention to 2 points in Figure 1. Point two represents the initiation of weekly interdisciplinary CLABSI rounds. Point three represents 2 premature infants, atypical for unit census, on extracorporeal membrane oxygenation with hemodialysis catheters that required off-label use of Prismaflex. Conclusions: Engagement of a microsystem’s interdisciplinary team to focus efforts on identifying and addressing real-time concerns to central lines has led to a short-term decrease in CLABSI rate. Sustaining this decrease in CLABSIs will require continual reassessment of the effectiveness of strategies utilized. Additional PDSA interventions as a result of the weekly rounds are being investigated, including the use of antimicrobial sheets for high-risk patients, the creation of unit-specific prepackaged sterile central line dressing kits, and transitioning from alcohol to chlorohexidine scrubs for hub accessing.Fig

Characterizing the relationship between coronavirus disease 2019 (COVID-19) and central-line-associated bloodstream infection (CLABSI) and assessing the impact of a nursing-focused CLABSI reduction intervention during the COVID-19 pandemic.

To examine the impact of SARS-CoV-2 infection on CLABSI rate and characterize the patients who developed a CLABSI. We also examined the impact of a CLABSI-reduction quality-improvement project in patients with and without COVID-19. Retrospective cohort analysis. Academic 889-bed tertiary-care teaching hospital in urban Los Angeles. Inpatients 18 years and older with CLABSI as defined by the National Healthcare Safety Network (NHSN). CLABSI rate and patient characteristics were analyzed for 2 cohorts during the pandemic era (March 2020-August 2021): COVID-19 CLABSI patients and non-COVID-19 CLABSI patients, based on diagnosis of COVID-19 during admission. Secondary analyses were non-COVID-19 CLABSI rate versus a historical control period (2019), ICU CLABSI rate in COVID-19 versus non-COVID-19 patients, and CLABSI rates before and after a quality- improvement initiative. The rate of COVID-19 CLABSI was significantly higher than non-COVID-19 CLABSI. We did not detect a difference between the non-COVID-19 CLABSI rate and the historical control. COVID-19 CLABSIs occurred predominantly in the ICU, and the ICU COVID-19 CLABSI rate was significantly higher than the ICU non-COVID-19 CLABSI rate. A hospital-wide quality-improvement initiative reduced the rate of non-COVID-19 CLABSI but not COVID-19 CLABSI. Patients hospitalized for COVID-19 have a significantly higher CLABSI rate, particularly in the ICU setting. Reasons for this increase are likely multifactorial, including both patient-specific and process-related issues. Focused quality-improvement efforts were effective in reducing CLABSI rates in non-COVID-19 patients but were less effective in COVID-19 patients.

Sustaining Improvements in CLABSI Reduction in a Pediatric Cardiac Intensive Care Unit.

Introduction:Central line-associated bloodstream infections (CLABSIs) are preventable events that increase morbidity and mortality. The objective of this quality project was to reduce the incidence of CLABSIs in a pediatric cardiothoracic intensive care unit.Methods:Institutional review of an unacceptably high rate of CLABSIs led to the implementation of 4 new interventions. These interventions included: the use of sequential cleaning between line accesses, Kamishibai card audits, central line utilization and entry audits, and proctored simulation of line access.Results:There was a reduction in CLABSI rate from 1.52 per 1,000 central line days in 2018 to 0.37 per 1,000 central line days in 2020 and 0.32 in 2021. Additionally, central line days per 100 patient days decreased from 77 to 70 days over the study period. The cardiothoracic intensive care unit went 389 days without a CLABSI from October 2020 to November 2021.Conclusions:Implementation of multiple interventions led to a successful reduction in the incidence of CLABSIs in our unit, with a sustained reduction over 1 year.

Implementation of Evidence-based Maintenance Bundles to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) Rates

Background In 2021, an increase in central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) rates was observed at an academic medical center. CLABSI and CAUTI have a significant impact on patient outcomes including mortality, length of stay, and healthcare costs. Reduction of CLABSI and CAUTI incidence can be achieved through implementation of standardized, evidence-based maintenance bundles for central lines and foley catheters. Methods A multidisciplinary team began meeting weekly in July 2021 to review CLABSI and CAUTI rates, insertion and maintenance practices, product utilization, and education initiatives. Standardized central line and foley catheter maintenance bundles were developed based on current infection prevention evidence-based guidelines. In August 2021, the maintenance bundles were implemented on every unit and education was provided to nursing unit leaders and staff by the infection prevention department. The maintenance bundles are maintained through daily audits by nursing unit leaders and weekly validation audits by the infection prevention department. Observations from the weekly validation audits are documented and reviewed on a weekly basis by the multidisciplinary team and influence ongoing education topics. Results Between August and November 2021, a 4% reduction in CLABSI rate (2.2 per 1,000 device days) and a 19% reduction in CAUTI rate (2.9 per 1,000 device days) was observed compared to the baseline period. The central line maintenance bundle compliance increased by 21% from August to November with a maximum monthly compliance of 84%. The foley catheter maintenance bundle compliance increased by 23% with a maximum monthly compliance of 79% during the same time period. Conclusions A standardized, evidence-based maintenance bundle for central lines and foley catheters contributes to the reduction of CLABSI and CAUTI rates. Continuous monitoring and validation of the maintenance bundles provides guidance, accountability, and feedback for staff and highlights issues and trends that can be addressed through education. In 2021, an increase in central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) rates was observed at an academic medical center. CLABSI and CAUTI have a significant impact on patient outcomes including mortality, length of stay, and healthcare costs. Reduction of CLABSI and CAUTI incidence can be achieved through implementation of standardized, evidence-based maintenance bundles for central lines and foley catheters. A multidisciplinary team began meeting weekly in July 2021 to review CLABSI and CAUTI rates, insertion and maintenance practices, product utilization, and education initiatives. Standardized central line and foley catheter maintenance bundles were developed based on current infection prevention evidence-based guidelines. In August 2021, the maintenance bundles were implemented on every unit and education was provided to nursing unit leaders and staff by the infection prevention department. The maintenance bundles are maintained through daily audits by nursing unit leaders and weekly validation audits by the infection prevention department. Observations from the weekly validation audits are documented and reviewed on a weekly basis by the multidisciplinary team and influence ongoing education topics. Between August and November 2021, a 4% reduction in CLABSI rate (2.2 per 1,000 device days) and a 19% reduction in CAUTI rate (2.9 per 1,000 device days) was observed compared to the baseline period. The central line maintenance bundle compliance increased by 21% from August to November with a maximum monthly compliance of 84%. The foley catheter maintenance bundle compliance increased by 23% with a maximum monthly compliance of 79% during the same time period. A standardized, evidence-based maintenance bundle for central lines and foley catheters contributes to the reduction of CLABSI and CAUTI rates. Continuous monitoring and validation of the maintenance bundles provides guidance, accountability, and feedback for staff and highlights issues and trends that can be addressed through education.

EXPERIENCE OF CLABSI PREVENTION MEASURES IN A MEDICAL ICU IN A TERTIARY CARE HOSPITAL IN A DEVELOPING COUNTRY

TYPE: Abstract TOPIC: Education, Research, and Quality Improvement PURPOSE: To reduce the incidence of CLABSI (central line associated bloodstream infection) in the Intensive care unit (ICU) handling medical patients in a tertiary care setup. METHODS: Baseline data were collected for the first 6 months. Training for doctors, nurses and technicians provided in fixed intervals for implementation of 5 bundles of prevention, especially hand hygiene. RESULTS: There was a significant fall (25.3 Vs 8.1) in CLABSI rate soon after every educational programme conducted. However, it was followed by a rise again. There was no overall improvement in CLABSI rate after the intervention part (18.4 Vs 19.5). However, subgroup analysis showed that the outbreak of flu season in the second part of the year in the intervention phase made the population incomparable, with more ARDS cases in the second half with high SOFA score. CLABSI rate comparison between ARDS population containing months in the first half and the second half was done, which showed 15.5% reduction. Also, there was a significant increase in hand hygiene rate pre and post intervention (p<0.05). CONCLUSIONS: Fall in CLABSI rate in the months soon after the educational programme is evident but it was ill-sustained. Further, overall comparison did not yield significant reduction as the two populations were heterogeneous. However, reduction in CLABSI rate in the ARDS population showed intensive and continuous educational efforts can make significant improvements. CLINICAL IMPLICATIONS: Intensive and continuous teaching programmes can cause significant reduction in CLABSI in resource limited settings which may prove cost effective, when compared to treating resistant infection with costly antibiotics. DISCLOSURE: Nothing to declare. KEYWORD: CLABSI

Reducing Central Line Associated Bloodstream Infections in Allogeneic Hematopoietic Stem Cell Transplant Patients

Background: The blood and marrow transplant (BMT) unit at Cleveland Clinic had an increased rate of central line associated bloodstream infections (CLABSIs) in 2020 for allogeneic transplant admissions from an expected average of 1 per month to 4 in August of 2020. We aimed to reduce the number of CLABSIs in allogeneic BMT patients during their transplant admission to an average of 1 per month.Patientsand Methods: We formed a multidisciplinary team with nursing, advanced practice providers (APPs), infection prevention, fellows, residents, BMT staff, and Taussig quality improvement staff. We underwent training through the SolVE (Solutions for Value Enhancement) program, with biweekly meetings for training and coaching sessions to help design and support the quality improvement project.Results: We performed an initial data review of CLABSIs from January 2020 until September 2020 with a total of 13 cases identified. 53% of cases were female, 76% of patients were neutropenic, 53% of patients had mucositis, 61% of patients had diarrhea and 7% of patients had graft versus host disease. Patients had the following underlying diagnoses: myelodysplastic syndrome (4), acute myeloid leukemia (3), acute lymphoblastic leukemia (4) and diffuse large B-cell lymphoma (1). Central line data revealed that all lines were placed at Cleveland Clinic. 76% of lines were removed after identification of infection, 46% of lines had signs of infection or malfunction. Microbiologic data culture revealed that 7 cases were Pseudomonas aeruginosa, 3 Staphylococcus epidermidis, 1 vancomycin-resistant Enterococcus faecalis, 1 Streptococcus mitis and 1 Stenotrophomonas maltophilia.To build our process map we performed a Gemba walk where we observed central line use and access on the BMT unit. We conducted a root cause analysis and identified the following factors as drivers of the rise in CLABSIs: severe immunocompromised state, pre-existing infections, long duration of line present, frequent access, excessive line manipulation, and poor hand hygiene.The changes that were implemented on the unit included: retraining of all nurses on central line care, central line care being added as a topic to the annual competency review, site and tubing checks were to be performed at the time of bedside handoff at shift change, increasing Shine Audits to 40 per week from 10 on average and deep clean of nursing unit by EVS following outbreak of pseudomonas.Following the above interventions, we decided to form a CLABSI review meeting to review each CLABSI in real time and to be able to have a longitudinal comprehensive data collection of factors contributing to each case. These meetings involve nursing, infection prevention, APPs, and physicians directly involved with the patient's care. Data is stored in Redcap and includes patient factors (admission date, conditioning regimen, type of transplant, disease data), line factors (placement date, location, infection date, line removal date), microbiologic data (organism, reason for culture collection), personnel factors, maintenance/environmental factors and space for other comments. Data is presented at regular quality meetings with the section chair to develop further quality improvement projects.Initially the reduction of CLABSI rates did not reach our objective: we had 5 CLABSIs from January to February 2021. However, in the following months (March to June, 2021) we were able to reach our objective of 0-1 CLABSI's per month.ConclusionWe continue to work as a team to reduce the number of infections in the BMT unit. Next steps include continuing CLABSI review meetings, discussions with ICU to better understand indications and process of blood culture collections, discussion with infectious disease for input on other strategies for CLABSI reduction and examining central line processes in other institutions. DisclosuresSobecks: CareDX: Membership on an entity's Board of Directors or advisory committees.

Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days

Purpose of ReviewWhile reducing unnecessary days present of central venous catheters (CVCs) is part of central line associated bloodstream infection (CLABSI) best practices, there is limited information regarding compliance with this recommendation as well as addressing barriers to compliance.Recent FindingsSignificant work has been directed towards daily audits of necessity and improving communication between members of the medical team. Other critical interventions include utilization of the electronic health record (EHR), leadership support of CLABSI reduction goals, and avoiding CVC placement over more appropriate vascular access.SummaryInstitutions have varied approaches to addressing the issue of removing idle CVCs, and more standardized approaches in checklists as well as communication, particularly on multidisciplinary rounds, will be key to CVC removal. Utilization of the EHR for reminders or appropriate documentation of necessity is a factor. Avoidance of placing a CVC or appropriateness of the CVC is also important to consider.

Bridging the gap: introduction of an antimicrobial peripherally inserted central catheter (PICC) in response to high PICC central line-associated bloodstream infection incidence.

To reduce the incidence of central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters (PICC) through the introduction of an antimicrobial (AM) catheter as recommended in evidence-based guidelines and standards. Quality improvement project comparing incidence of infections pre-implementation and postimplementation of the new catheter. A 582-bed community teaching hospital in Northwest Indiana. Pre-implementation analysis of surveillance data indicated that 50% of CLABSIs occurred inpatients with PICCs in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an AM catheter was supported in each of the documents consulted. After introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures. After 30 months of data collection, the PICC CLABSI incidence reduced from a baseline rate of 1.83/1000 PICC days to 0.162/1000 PICC days (91.15% reduction, P=0.0002). Combined with continued compliance with basic prevention strategies (ie use of a central line insertion checklist/insertion bundle) and optimization of device selection and lumen justification, the introduction of an antimicrobial/antithrombogenic (AM/AT) PICC was associated with a significant reduction in CLABSI.

Development of a clinical practice guideline for weaning and discontinuing parenteral nutrition in hospitalized children as part of a central line-associated bloodstream infection-focused quality improvement initiative.

Overprescribing of parenteral nutrition (PN) increases costs and risks to patients, including from central line-associated bloodstream infection (CLABSI). With CLABSI reduction in mind, our children's hospital began an iterative quality improvement effort to decrease PN utilization by first ensuring appropriate initiation and then defining and ensuring appropriate discontinuation. Education was launched along with audits to evaluate for appropriate PN indications. Next, a literature review was conducted to guide the development of an algorithm to appropriately wean and discontinue PN. Lastly, all PN discontinuations were audited for agreement with the new guideline. Retrospectively, monthly PN utilization index (orders per patient-day) was plotted on a statistical process control chart to assess change over time. The presence of PN as a risk factor for CLABSI events and the overall hospital CLABSI rate were trended. Mean PN utilization index fell from 0.156 (July 2018 to January 2019) to 0.12 (February 2019 to August 2020) (P < .01). For 18 months, no PN utilization index reached the baseline lower control limit of 0.144, demonstrating special-cause variation and sustained change. PN as a risk factor for hospital CLABSI cases decreased from most prevalent (49% of cases) to fifth most prevalent (29%) as the CLABSI rate trended down. Engaging frontline staff in the development of a clinical practice guideline and increased accountability to reduce potential patient harm led to a significant and sustained reduction in PN utilization, as well as decreased prevalence of PN as a risk factor in hospital CLABSI cases.

Prevention of Central Line-Associated Bloodstream Infections Through Educational Interventions in Adult Intensive Care Units: A Systematic Review.

Central line-associated bloodstream infections (CLABSIs) represent a severe systemic threat to patients admitted in ICUs and contribute to increased mortality, prolonged length of stay in ICUs, and increased costs. The majority of CLABSIs are preventable. The current systematic review aimed to investigate the effectiveness of educational methods on CLABSI rates in adult ICUs.A systematic literature search was conducted using the electronic databases of Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Cochrane Database of Systematic Reviews for studies published from the beginning of 1995 to March 2020. The terms used for the search were as follows: central venous catheters, infection, central line-associated bloodstream infections, intensive care unit, and education intervention in all possible combinations and using the word ‘and’ between them. Data were extracted independently and crosschecked by two authors using a standard data collection form. The quality of the studies included in the review was assessed using the Methodological Index for Non-randomized Studies (MINORS).The current systematic review included 27 interventional studies of central line insertion or maintenance or both in adult ICU settings with documentation of the CLABSI incidence expressed per 1,000 catheter days. A large deviation between the length of time and type of educational interventions was found.Statistical significance was found in all studies (except one) in terms of CLABSI reduction despite the large variation of the length or the type of the educational intervention. Continuing education on infection prevention may be necessary to maintain the post-intervention results and improve clinical outcomes.

Bridging the Gap: Introduction of an Antimicrobial Peripherally Inserted Central Catheter (PICC) in Response to High PICC Central Line-Associated Bloodstream Infection Incidence

Highlights Abstract Objective: To reduce the incidence of central line-associated bloodstream infection (CLABSI) in peripherally inserted central catheters (PICC) through the introduction of an antimicrobial (AM) catheter as recommended in evidence-based guidelines and standards. Design: Quality improvement project comparing incidence of infections pre-implementation and postimplementation of the new catheter. Setting: A 582-bed community teaching hospital in Northwest Indiana. Methods: Pre-implementation analysis of surveillance data indicated that 50% of CLABSIs occurred in patients with PICCs in situ. A gap analysis was performed to review institutional practices against evidence-based recommendations. The use of an AM catheter was supported in each of the documents consulted. After introduction of the new device, performance was measured in a prospective manner using standardized Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) surveillance protocols for CLABSI and internal data sources for other measures. Results: After 30 months of data collection, the PICC CLABSI incidence reduced from a baseline rate of 1.83/1000 PICC days to 0.162/1000 PICC days (91.15% reduction, P = 0.0002). Conclusion: Combined with continued compliance with basic prevention strategies (i.e., use of a central line insertion checklist/insertion bundle) and optimization of device selection and lumen justification, the introduction of an antimicrobial/antithrombogenic (AM/AT) PICC was associated with a significant reduction in CLABSI.

Intentional Collaborative Rounds Focusing on Eyes on the Lines: A CLABSI Reduction Project

Background : Prevention of central line-associated bloodstream infections (CLABSI) is critical to reducing prolonged hospital stay, cost, and preventable deaths. Despite the use of evidence-based practices (EBP) for the care and maintenance of a central line (CL), reducing CLABSI is a daunting task and carries broad effects for the health care system. This project examined the relationship of intentional collaborative rounds (ICR) on EBP for care and maintenance of a CL in a cardiovascular intensive care unit (CVICU). The aim of this project was to assess for missed CL care and maintenance interventions, identify barriers to implementing these practices, and recommend solutions to reduce CLABSI rates. Methods : ICR were conducted on a 13 bed CVICU in a tertiary care, academic hospital located in the Midwest. A checklist was used to assess compliance of EBP on the care and maintenance of a CL. Results of the assessments were shared with bedside nurses and displayed on a Pareto chart for staff to review. Results : The ICR intervention resulted in improvement for each of the nine EBP components used in the care and maintenance of the CL when comparing from baseline to the project's end. Intact CL dressings and proper placement of the chlorhexidine gluconate (CHG) disk as part of the EBP recommendations were particularly problematic. To overcome these barriers, an updated CHG impregnated dressing was recommended by infection prevention nurses and a new product pilot was incorporated into the ICR project. Findings from the new CHG dressing pilot showed improvement in the dressing not intact (p Conclusions : Using a structured approach such as ICR to identify barriers, supports the work to move evidence into practice, serves as a vehicle for sharing best practices, and ultimately reduces CLABSI rates.

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.