CLABSI Elimination: It Takes a Team to Reach Zero

Purpose:
In January 2010, a Nursing Staff/Infection Prevention Performance Improvement (PI) team was chartered to address CLABSI in our facility. The team formulated a “CLABSI Problem Statement Tool,” and a PI plan, with a goal of eliminating CLABSI's at our facility.

Significance:
CLABSI's adversely affect patient outcomes and substantially increase hospitalization costs. During the 4th Quarter 2009 and 1st Quarter 2010, the CLABSI rate for the ICU was significantly above the median for comparable hospitals in NDNQI.

Strategy and Implementation:
In January 2010, a Nursing Staff/Infection Prevention Performance Improvement (PI) team was established to address CLABSI at our facility. The teams' membership included bedside caregivers, nursing management personnel and the Infection Prevention Manager. Since previously established CLABSI bundle measures were already in place, the team postulated that additional measures beyond the established care bundle (the extended bundle) would be necessary, and that monitoring of more measurable care parameters would be essential. The team's initial task was the identification of various factors contributing to CLABSI occurrence. Each barrier to infection prevention was then weighted. This information was used to formulate the CLABSI Problem Statement and a PI plan. The PI project and interventions included: hub/tubing maintenance, a CHG scrub-the-hub campaign, CHG bath to decrease the microbial bioburden on patient skin and on-going extended bundle compliance monitoring.

Evaluation:
Since implementation of the extended bundle measures in January 2010, there have been no CLABSI's in the ICU and only one non-ICU CLABSI in the entire hospital.

Implications for Practice:
Focus on primary bundle intervention may be effective in the short-term, but sustained improvement requires front-line staff involvement, prompt problem identification, ongoing monitoring, and the need to develop further intervention when gaps in care are identified.