Reduction in Central Line Associated Blood Stream Infection (CLABSI): An Comprehensive Approach

Purpose:
The purpose of the quality improvement project was to develop and implement a comprehensive approach to reduce CLABSI in our Medical Critical Care unit (MCC).

Significance:
Over 250,000 bloodstream infections related to central lines occur in the US each year. This cost billions to hospitals. This is not taking into account the costs to families and loss of productivity as well as emotional, physical and personal costs that are difficult to quantify and measure.

Strategy and Implementation:
An all-inclusive approach to address the reduction of CLABSI in our MCC unit was developed. Teams were developed that worked on insertion, maintenance, surveillance, education and compliance. Policies related to insertion of central lines were redone, allowing the nurse the power to stop the process at any time. Maintenance of central lines was monitored for daily adherence to policy. On the spot education to staff was provided if noncompliance was found. Training was provided and reviewed frequently. A research project was conducted to determine the best approach of cleaning ports. A bundle approach was developed and implemented, addressing dressing and tubing changes and troubleshooting central lines. All patients transferred into the unit with a central line in place were cultured for pre-existing infection. Information related to CLABSI was posted on the unit to increase awareness of the staff. NDNQI data was used to measure the overall improvement on CLABSI in the unit.

Evaluation:
From July through November 2011, there were 231 lines placed, giving 98.3% compliance with the central line vascular bundle. Our multi-angle approach has exhibited an 84% reduction in CLABSI rates over a period of 26 months.

Implications for Practice:
Empowering nurses to control the central line insertion and reducing CLABSI in our patient population allows our patients to be safer. Additionally, the structured practice that we have implemented allows nurses straight forward direction to guide their practice.