Reducing Central Line Associated Blood Stream Infections through a Medical Center-wide Multidisciplinary Initiative

Purpose:
Central line associated blood stream infections (CLABSI) continued to be an area of concern for our organization. Our goal was to decrease our CLABSI rate by at least 10% through a multidisciplinary initiative that focused on the standardization of practice across the continuum of patient care.

Significance:
CLABSI, a significant cause of morbidity and mortality in hospitalized patients, has been identified as a never event. The Centers for Medicare and Medicaid Services no longer reimburse for CLABSI-associated costs of care as an incentive to improve the quality of care and reduce health care costs.

Strategy and Implementation:
A taskforce representing nursing, infection control, patient safety, medicine, clinical documentation and supply chain was formed to develop a multidisciplinary approach to address CLABSI. Based on evaluations of past initiatives, the taskforce focused on the continuum of patient care across the medical center. Standardized nursing practice for accessing and maintaining central lines was taught via computer-based training (CBT) and reinforced through 1:1 return demonstration by 1,452 nurses from clinics, procedural areas, inpatient units, emergency departments and home health services. 150 providers were educated on proper line placement via CBT followed by simulation validation. Central line insertion is monitored by a trained observer. The procedure is documented by the observer and inserter utilizing a standardized checklist. Standardized pediatric and adult insertion and dressing change kits were implemented. CLABSI rates were calculated and reported on a monthly basis.

Evaluation:
We met our initial goal of decreasing our CLABSI rate by 10% within the first two months of starting this initiative. To date, we have achieved a 50% reduction; our rate is currently 0.5 CLABSI/1000 central line days, down from 1.01 CLABSI/1000 central line days.

Implications for Practice:
Our multidisciplinary initiative that included all patient populations, across all areas and units, has resulted in a 50% decrease in CLABSI. Practice and supply standardization coupled with staff and provider education resulted in a greater decrease in CLABSI than prior initiatives in less time.