Beating the Benchmark: Sustained Success in CLABSI Rate Reduction in a Surgical Trauma Burn ICU

Purpose:
Describe the core strategies in creating a culture of safety within a Surgical Trauma Burn ICU (STBICU) moving CLABSI rates 6 times above the national benchmark in 2009 to sustaining rates below benchmark in 2012.

Significance:
Central line associated blood stream infections continue to challenge health care systems across the nation with approximately 41,000 infections occurring each year. Prevention is imperative to decrease hospital length of stay, healthcare costs and risk of mortality.

Strategy and Implementation:
Nursing leaders implemented a multi-pronged approach targeting insertion and maintenance best practice. Three of the core strategies included hardwiring review of line necessity, prompt removal of lines when adherence to aseptic technique could not be assured, and monthly maintenance audits. Daily documentation prompts review of line necessity within LIP progress notes and nursing central line assessments. The Trauma ICU team reevaluated the need for central lines in all trauma alerts and increased peripheral IV use. Removal of outside hospital and trauma bay lines occur within 24 hours versus recommended 48 hours. Nurse peers perform monthly central line maintenance audits providing in-the-moment feedback and education on aseptic dressings and accessing of lines. Repetitive discussion at unit staff and practice meetings as well as posting of current data, including infection-free days, keeps our unit accountable to our goal of achieving rates below national benchmarks.

Evaluation:
The CLABSI rate in Quarter 3 2009 was 14.4 per 1000 central line days. The STBICU continued a downward trend through 2010 and 2011 and has been below the benchmark of 1.4 CLABSIs/1000 central line days for 3 consecutive quarters (Quarter 3 2011 through Quarter 1 2012).

Implications for Practice:
The key strategies implemented within the STBICU are practical and replicable within other surgical-trauma ICUs. Commitment to a culture of safety enables an ICU to successfully reach CLABSI rates below benchmark.