Reducing Central Line Associated Blood Stream Infections (CLABSI) using a multidisciplinary collaborative approach

Purpose:
Central line associated bacteremias are a significant cause of patient morbidity & mortality and increased cost. The literature emphasizes central line insertion & management in the ICU, but other factors/locations need to be considered: environment, transport, and site access/line maintenance.

Significance:
The development of associated procedures, CLABS carts, a checklist to facilitate adherence to the CLABS bundle, were not sufficient to achieve a CLABS rate of 0. Sustenance of a reduced CLABS rate required continuous literature review, adoption of new practices and teamwork amongst all disciplines

Strategy and Implementation:
In addition to implementation of the CLABS checklist and CLABS bundle, a multidisciplinary collaborative approach was utilized to reduce CLABS organization-wide. It was based on 1)evidence based literature review and vigilance, 2)procedure development for central line insertion, line maintenance & line access, 3)conducting a root cause analysis every time a bacteremia was identified, 4)ongoing education for professional/non-professional staff to ensure meticulous technique for every step related to management of the central catheter 5) education of patient families, 6)inclusion of housekeeping to form a "clean team" for patient areas, 7)utilization of the Six Sigma Rapid improvement event (RIE)process for PICC lines, 8)openness to new devices, processes and practices. The process originated in the MICU but expanded to all areas of the hospital including the OR,ED,radiology and transport.

Evaluation:
The CLABS/1000 line days decreased significantly over the course of time (75% from 1st qtr '05 to 4th qtr '09). A timeline for this period will be used to illustrate the interventions which helped to reduce CLABS, particularly as the process was expanded to other areas. Ongoing challenges persist.

Implications for Practice:
It takes more than a checklist to reduce CLABS. Aseptic technique, protecting the integrity of the site & line in every area (including transport,radiology),administrative leadership support, collaboration,vigilance,ongoing education,implementation of innovative strategies all contribute to success.