Creating a Culture of Zero Tolerance for Central Line- Associated Bacteremia

Purpose:
Patients with central lines are more susceptible to getting a central line-associated bacteremia (CLAB). Through education, observations, collecting metrics, and transparency in feeding back the rates to the intensive care unit staff the goal was to create a culture of zero tolerance for CLAB.

Significance:
Annually, the Centers for Disease Control (CDC), estimate 250,000 cases of CLAB. The attributable mortality is 12%-25%, additional patient length of stay in the ICU and the hospital 7 – 10 days with the associated costs of caring for these patients $296 million - 2.3 billion.

Strategy and Implementation:
In 2006, the infection prevention nurse observed an increase in CLAB in the Medical Surgical Intensive Care Unit (MSICU). At this time a CLAB education module was given to all nurses in the MSICU. After the module was implemented the MSICU went 212 days without a CLAB. After celebrating this accomplishment, a CLAB was identified in the MSICU. The nurses and administration were very upset to learn about the CLAB. The nurses and managers kept reviewing with the infection prevention nurse the details of the CLAB, because they just could not believe this had happened in their MSICU. The infection prevention nurse performed observations surrounding central line access. The observations showed nurses not accessing the port hub properly prior to injecting into the line. In response, a scrub the hub bundle was implemented and posters on scrub the hub were strategically placed in the MSICU.

Evaluation:
The MSICU has not had a CLAB for a year and a half. The CLAB rates and days since the last CLAB using graphs are shared with the ICU staff monthly. Through annual education, observations, collecting metrics, and transparency in feeding back the rates to the MSICU staff the culure was changed.

Implications for Practice:
Creating a culture for zero tolerance for CLAB improves patient care by reducing mortality, the number of days in the ICU and the hospital, and associated costs. Additionally, this creates a culture of success among the nurses, increasing nursing ownership and nursing morale.