Going Beyond the Bundle: Ensuring Best Practices in the Prevention of Central Line Blood Stream Infections

Purpose:
The prevention of Central Line Associated Bloodstream Infections (CLABSI) continues to be a challenge in hospitalized patients. Through a unique approach to implementing evidence based strategies we strive to eliminate the incidence of CLABSI throughout our hospital system.

Significance:
It is estimated that 250,000 CLABSI occur annually in hospitals. Incidence of CLABSI is directly related to an increase in patient morbidity and length of stay. Financial concerns are ever increasing as these infections independently increase hospital cost and negatively affect reimbursement.

Strategy and Implementation:
In recent years, more stress has been placed on benchmarking CLABSI rates to demonstrate excellence concerning this nurse sensitive indicator. Hospitals have worked to implement evidence based strategies to prevent the incidence of CLABSI that focus on the insertion and maintenance bundles. These strategies have shown a decrease in CLABSI rates but in order to perform at a level of excellence more innovative strategies are necessary. Strategies such as daily rounding of all central lines by a group of highly qualified nurses dedicated to the care of vascular access has been implemented. House-wide audits are performed by bedside nursing staff. Technologies that arm our nurses with the skills to avoid the use of central lines have been trialed and subsequently spread throughout the institution. This community based hospital has demonstrated that through innovation and ownership, it is possible to eliminate the incidence of CLABSI in hospitalized patients.

Evaluation:
Through the work of a nurse driven committee, a significant decrease in CLABSI rates including a rate of 0 for 14 months in all critical care areas has occurred. By benchmarking with the NDNQI, excellence has been demonstrated by outperforming the mean rate of other hospitals in the database.

Implications for Practice:
Utilizing innovative strategies to further develop the CLABSI prevention bundles has demonstrated a positive impact on infection rates. Strategies implemented are practical, feasible and replicable in other hospital and health care settings.