Every Line Every Day - CLABSI Reduction Outside of the Intensive Care Setting

Purpose:
In line with the ANA/AONE Principles for Collaborative Relationships between Clinical Nurses and Nurse Managers and national initiatives to reduce harm to hospitalized patients, an interdisciplinary team was tasked with reducing the CLABSI rate on a non-ICU pilot unit from baseline to zero.

Significance:
CLABSI's have an attributable morbidity rate of between 4% & 20% making elimination an organizational patient safety priority. Analysis of the differences between ICU and non-ICU units found that non-ICUs did not have the same culture of accountability for central line maintenance and monitoring.

Strategy and Implementation:
The non-ICU unit with the highest line utilization and infection rates was selected to implement a pilot program “Every Line Every Day” as a small test of change. The unit and details for clinical focus were identified by gap analysis. The program consisted of several elements. 1. Standardization of processes based on evidence based practice. 2. Identification of failures and clinical practice variations through intensive daily auditing of each central line by the Unit Manager, Safety Nurse Coordinator or Unit Safety Nurse. 3. Immediate feedback on deviation utilizing a mentoring non-punitive approach with positive feedback given for care that met standard as well. In addition to the above practices, the following activities continued as previously implemented prior to the pilot: monthly trending of lumen occlusion rates, root cause analysis conducted on all identified infections with tracking and trending of attributable factors, and data driven educational initiatives.

Evaluation:
Unit efforts resulted in 8 months with zero CLABSIs versus 5 in the prior 2 months. Common practice variations identified included failure to assess & document every shift, late dressing changes, loss of dressing integrity, failure to label lines & lack of compliance with lumen flushing policy.

Implications for Practice:
Lessons learned support the establishment of learning environments and cultures. Direct involvement of the Nurse Manager increased staff knowledge and accountability while concurrent feedback motivated staff to take ownership of clinical practice and CLABSI rates while fostering team building.