Driving the CLABSI Rate to Zero: Building on prevention with strategic practice and cost-saving interventions

Purpose:
Evidence-based nursing practice and protocols to reduce CLABSIs and improve patient outcomes have become the cultural healthcare norm. The goal of this initiative was to build on initial CLABSI-reduction success to drive elimination of CLABSI.

Relevance/Significance:
41,000 patients per year acquire a central line-associated blood stream infection (CLABSI) in the United States. CLABSI is the most deadly hospital-acquired infection, with mortality rates near 20%. This with excess cost per case of approximately $17,000 make it essential for hospitals to examine practices and processes to further reduce or eliminate CLABSI. Implementation of prevention bundles provides a foundation for additional evidenced-based intervention, guiding elimination initiatives.

Strategy and Implementation:
In 2012, implementation of an evidence-based CLABSI prevention bundle focused on daily audits, infection surveillance, and education (intravascular catheter care and prevention bundle for catheter maintenance). In 2013, antimicrobial PICCs were implemented for high-risk patients and assessment of catheter need was hard-wired into ICU rounding and each insertion event. Evidentiary review identified CHG bathing as a second tier intervention, and a decision was made to add CHG bathing to the central line bundle. 2014 to current, fully integrated protocol practices into new-hire and float pool orientation to enhance novice practitioner competence. The Vascular Access Specialist team is a valuable staff resource, sustaining a culture of safety, conducting daily audits to validate prevention bundle adherence, facilitating just-in-time peer review, teaching, and providing unit-specific compliance data.

Evaluation:
Hospital-wide prevention bundle adherence improved from 60% to 86%. CLABSI rates decreased from 1.02/1,000 catheter days (June 2012) to ZERO from June 4, 2013 - April, 2015. Associated cost savings exceeded $300,000, with accompanying avoidance of potential harm to patients. This 102% rate reduction reflects 634 days of hospital-wide CLABSI-free practice, and 743 days ICU CLABSI-free practice.

Implications for Practice:
Driving CLABSI to zero can be accomplished through evidence-based bundle implementation combined with nursing- and communication-focused strategies, intentional evaluation of central line need/discontinuation, and integration of vascular access education and support responsibilities.