Reduction of Central Line-Associated Blood Stream Infection Rates in the SICU

Purpose:
A quality improvement project was conducted in a 20-bed University Hospital Surgical Intensive Unit with the goal of reducing the incidence of Central Line-Associated Blood Stream Infections from a rate of 4.5 and 2.4 per 1,000 central line days in 2007 and 2008, respectively, to a rate of zero.

Significance:
Central Line-Associated Blood Stream Infections (CLABSI) represent a significant patient safety risk and are preventable by adopting proven strategies to reduce risk of contraction. In addition to improved patient outcomes, significant financial savings may be achieved through CLABSI reduction.

Strategy and Implementation:
PDCA methodology was used to address the problem. A literature review was conducted to discover and implement best practice. A checklist for a central line insertion/maintenance bundle was put into place and audited each shift that included hand hygiene, full barrier precautions, chlorhexidine skin antisepsis, proper dressing maintenance, and proper line maintenance. These audits were publicized to staff in the SICU. Nurses were empowered to stop non-compliant practices. A new dead space-reducing hub was used that was color coded to improve compliance with bi-weekly hub-change protocol. Patients were bathed daily with 2% chlorhexidine-impregnated wipes. A stocked procedure cart was created to be used with central line placement procedures. The SICU manager and SICU Medical Director met regularly to review progress towards goal. Also, several meetings occurred between SICU team players and OR team to ensure proper insertion technique was followed in the surgical suite.

Evaluation:
The SICU has not observed a CLABSI since July of 2009. Results were measured as number of infections per 1,000 central line days. The CLABSI rates seen in the SICU between 2007 and 2010 were 4.5, 2.4, 1.3, and 0, respectively.

Implications for Practice:
These results underscore the fact that inappropriate insertion technique and line care can be a potential source of infection. Increased scrutiny on compliance by front-line staff, mainly nurses and physicians, can contribute to decreasing CLABSI risk.