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Quality Breakthrough: Reducing Central Line Blood Stream Infections to Zero
Intent or goal of the strategy was to reduce our central line blood stream infections (CLABSIs), since there was variation in our patient outcomes, with an ultimate goal of reaching and sustaining zero.
Significance:
Since the average cost of caring for a patient who develops a Central Line Blood Stream Infection is approximately $12,000, and our data showed variation in our outcomes, this issue was extremely important to address from both a cost and a quality perspective.
Strategy and Implementation:
Our data, submitted through NDNQI for 9 years, showed variation in performance and patient outcomes. A quality improvement team was formed to review our data, and develop an action plan for improvement, with a goal of reducing Central Line Blood Stream Infections (CLABSIs) to zero. The IHI (Institute for Healthcare Improvement) Central Line Bundles were implemented, with monitoring conducted on a daily concurrent basis. These Bundles include Insertion, Maintenance, and Nursing Bundle elements. Monthly bundle compliance results, as well as CLABSI results, are presented at staff meetings, and posted on bulletin boards in public areas. Additionally, hand hygiene mystery observations using the TJC (Joint Commission) Targeted Solution Tool, were implemented.
Evaluation:
Results have shown zero CLABSIs for the medical surgical floors for 12 consecutive months, and zero for ICU for 39 consecutive months. Since initiation of hand hygiene mystery observations, there has been a steady improvement, reaching 97.8% hand hygiene compliance for March 2013.
Implications for Practice:
These strategies can be easily transferred to other facilities. A team approach with direct nursing staff involvement in improvement efforts was a driving factor. Open communication and transparency of posting monthly results has been instrumental in motivating staff and sustaining the results.