INNOVATIVE STRATEGIES TO REDUCE CATHETER ASSOCIATED BLOODSTREAM INFECTION (CLABSI) RATES IN THE CRITICAL CARE UNIT

Purpose:
The goal for our unit is to achieve a central line associated blood stream infection (CLABSI) rate below the national benchmark and strive for zero line infection rates. We focused on appropriate central line usage, insertion, maintenance, and early removal to achieve a sustained rate of zero.

Significance:
Central line associated bloodstream infections (CLABSI) are associated with higher mortality rates, longer length of stay, and increased healthcare costs. The goal of an effective prevention program should be the elimination of CLABSI from all patient care areas.

Strategy and Implementation:
Central line insertion and maintenance bundles were implemented system wide in 2006 yet our rates remained above the national benchmark. In 2011, a multidisciplinary critical care team was developed to discuss action plans reducing CLABSI rates. Initial strategies were continuation of central line insertion bundle and implementation of designated Monday for central line dressing changes with application of Biopatch antimicrobial disc. Daily line surveillance occurred assessing for signs of infection and line necessity. Realizing this was not effective in reducing rates, we implemented daily chlorhexidine baths for all patients in ICU. This reduced rates but not to zero. In 2013, cleaning patient bed basins before and after each use with Cavi-wipe was initialed with further reduction noticed in CLABSI rates. With engaged staff and patient and family participation, we have developed better protocols and improved standards of care to guide our nursing practice.

Evaluation:
Initial CLABSI infection rates in FY 2011 was 1.5/1000 line days decreasing to 0.3/1000 in FY 2012 following the implementation of chlorhexidine baths. Creative strategies to Cavi-wipe bath basins has resulted in achieving a zero CLABSI rate for the last six months.

Implications for Practice:
Continuous education to staff, patients, and families and transparently sharing outcomes has increased awareness and fostered a culture of patient safety. This cost-effective CLABSI bundle has dramatically reduced infection rates in our population and is easily replicated.