Accomplishing Zero Bloodstream Infections with Chlorhexidine Gluconate Transparent IV Securement Dressing

Background:   Despite compliance with evidence based guidelines and “bundles” for the prevention of Central Line-Associated Bloodstream Infections (CLABSIs), the CLABSI rate in the critical care unit at St. Joseph's Mercy Health Center was 4.08/1,000 central line days for the 12 months prior to study.  Prior dressings included a transparent dressing with or without a silver alginate IV patch.

Objective:  Objective was to save lives, decrease cost and length of stay by reducing the number of CLABSIs to zero and sustaining the zero rate in the critical care unit.

Methods:  All patients in the 25 bed critical care unit with central lines over a 9 month period of time were included in this study.   The definition of CLABSI that is published by NHSN/CDC was used to determine if patients had CLABSI.  The dressing change protocol of using the Chlorhexidine Gluconate Transparent IV Securement Dressing and changing every Sunday or if dressing became loose or soiled was implemented January 1, 2009. Compliance with Chlorhexidine Gluconate Transparent IV Securement Dressing was monitored daily by the charge nurse when rounding to count central line days. 

Results:   Compliance with Chlorhexidine Gluconate Transparent IV Securement Dressing was 100%.  The goal of reaching Zero was accomplished and sustained for 9 consecutive months.  There have been no adverse reactions reported.  Staff and physician satisfaction has played a very important factor in compliance with the dressing.  Based on a 2-rate chi-square test, the rates of infections significantly decreased from the standard transparent dressing(a mean of 3.1 infections per 1,000 catheter days) to the Chlorhexidine Gluconate Transparent IV Securement Dressing (a mean of 0 infections per 1,000 catheter days, p<0.001). The 2-rate chi-square test assumes that infection counts follow a Poisson distribution.   Based on data published in On the CUSP: Stop BSI Central Line-Associated Blood Stream Infection Toolkit, the average attributable mortality related to CLABSI is 18% (0-35%), the length of stay associated with CLABSI on average is increased by 13 hospital days and the cost of each CLABSI is $45,254.  Actual estimates of mortality, length of stay and costs will vary by institution; these numbers are consistent with the most recent published data.  Based on the hospital's CLABSI rate of 4.08/1,000 days prior to the implementation of the Chlorhexidine Gluconate Transparent IV Securement Dressing, a potential of 4 patient deaths were prevented, a potential of 286 avoidable days were prevented and there was an estimated cost savings of $989,516.55 per year. 

Conclusions:   The results of the time period studied suggests that the use of a Chlorhexidine Gluconate Transparent IV Securement Dressing and evidence based “bundles”;  reduces the risk of bloodstream infections as well as saves lives, decreases length of stay and reduces costs associated with infections.