Reduction of Central Line Associated Blood Stream Infections (CLBSI) in Critical Care

Purpose:
To implement evidenced based best practices to eliminate central line associated blood stream infections (CLBSI) in the Critical Care unit.

Significance:
The rate of central line associated infections in our Critical Care unit was 2.4 in 2008 (between the NDNQI 50th - 75th percentile). The Institute for Healthcare Improvement estimates that CLBSI infections extends the length of stay seven days, and incurs additional cost up to $29,000 per infection.

Strategy and Implementation:
In May 2004, a Critical Care Clinical leader attended the National Teaching Institute for Critical Care (NTI) where the evidence regarding the Central Line Bundle and central line infection prevention (Institute for Healthcare Improvement (IHI) were presented. In 2005, a multidisciplinary team was formed to facilitate compliance with the Central Line Bundle. The Education Department developed teaching materials for staff. Inservices were videotaped for staff unable to attend a live inservice. A Healthstream course: Introduction to Vascular Access Devices, was developed for ongoing education. During orientation and annually, nurses are validated on Central Line Insertion and Care. Experts provide one to one coaching with medical and nursing staff when central lines are placed to reinforce compliance with following the evidenced based best practice guidelines. A central line tray and checklist was developed and placed in each tray for use when placing central lines.

Evaluation:
Every patient with a central line in the critical care unit is audited for presence of a hospital acquired CLBSI. As of March 2012, we have sustained forty five months without a central line associated infection in the critical care unit, which results in a cost savings of $44,400 - $348,000.

Implications for Practice:
Following current evidence to change practice for central line insertion and care using an interdisciplinary process improvement work group led by front line staff is an effective way to implement evidenced-based best practice models to eliminate hospital-acquired infections.