CLABSI - The problem is serious, the solution is simple

Purpose:
To reduce the number of Catheter Associated Bloodstream Infections (CLABSI) in one month after a sharp increase was noted.

Significance:
Approximately 41,000 annual CLABSIs with an estimated to cost $18,000 each. “CLABSI are the leading cause of death among health care- associated infections” (Faruqi, et al., 2012, p. e211). The infections also lead to significant morbidity and increased length of stay.

Strategy and Implementation:
Using Kotter's change model, we needed to quickly increase the sense of urgency by communicating the organizations sharp increase. A root cause analysis of the CLABSIs identified that the increase in infections occurred shortly after converting to a new needless device, and the organisms most often were those associated with normal skin flora. A team of stakeholders was formed and an action plan for rapid improvement was put in motion. In order to see and feel the change that was needed, a flyer showing organisms on the catheter tip after no preparation, a 5 second preparation, 10 second preparation and 15 second preparation was distributed. We then utilized a SWAT team approach to assure all staff who accessed lines did a return demonstration of scrubbing for 15 seconds. Each nurse leader completed 2 - 4 hours shifts and checked observed staff using a checklist.

Evaluation:
Our preintervention CLABSI rate, that was identified as a sharp increase was 3.34 infections per 1000 line days in September, 2012. The CLABSI rate during the intervention period in October, 2012 was 1.57. Post intervention, the CLABSI rate decreased to 0.70 in Nov. 2012 and was 1.13 in Dec. 2012.

Implications for Practice:
A sharp increase in a healthcare associated infection can be decreased when using a change model. Allowing staff to see/feel change, utilizing a SWAT team, involving all leaders, and requiring demonstrations of expected behaviors had a significant impact and rapidly improved patient outcomes.