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Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: Significant increases in CLABSI rates associated with NVS use have been reported; however, little data describe successful measures to reverse this trend other than discontinuing use of the valve. In 2/08, our hospital began using a NVS for all central lines.
Objective: We describe CLABSI rates prior to and associated with NVS use as well as the effectiveness of measures implemented to reduce them.
Methods: CLABSI rates were followed from baseline prior to NVS use (3/07 through 2/08), during NVS use (3/08 through 8/08), and after measures to reduce rates with NVS use (9/08 through 8/09). Of note, our hospital has been using the Institute for Healthcare Improvement insertion bundle for CLABSI prevention since 2007. Measures to reduce CLABSI rates after NVS use began included: weekly meetings of a zero BSI task force, analysis of potential factors contributing to CLABSI rates, as well as development and staged rollout of a CLMB. Major elements of the CLMB included: hand hygiene prior to access, mask use while line is open, standardized access disinfection, standardized dressing changes, and IV tubing and injection cap care. CLABSI rates for the three time periods were compared using chi-square analysis.
Results: The baseline housewide CLABSI rate for 12 months prior to NVS use was 4.45 per 1000 catheter days. This significantly increased over the first 6 months of NVS use to 6.41 per 1000 catheter days (OR 2.23, 95%CI 1.85-2.68, p<0.0001). In the 12 months after adopting the CLMB, the CLABSI rate significantly decreased to 3.57 per 1000 catheter days (OR 0.31, 95%CI 0.26-0.37, p<0.0001 compared to NVS use without the CLMB and OR 0.69, 95%CI 0.58-0.83, p<0.0001 compared to baseline). Compared to the NVS use period, after adopting the CLMB, we observed significant CLABSI rate decreases throughout the pediatric hospital (OR 0.50, 95%CI 0.42-0.61, p<0.0001), in non-ICU adult wards (OR 0.09, 95%CI 0.07-0.12, p<0.0001), as well as in adult ICUs (OR 0.39, 95%CI 0.32-0.48, p<0.0001). Among units where the CLMB has been in use the longest (two ICUs and two general wards), only 1 CLABSI has occurred (rate of 0.45 per 1000 catheter days) in the final three months of this analysis.
Conclusions: We observed a significant increase in the housewide CLABSI rate associated with NVS use; however, we successfully implemented a CLMB focusing on a standardized technique for line access as well as the general care of the line, and this was associated with a significant decrease in the CLABSI rate, which fell significantly below baseline. Future study of other institutions employing the use of a standardized CLMB would add valuable information regarding CLABSI prevention.
Objective: We describe CLABSI rates prior to and associated with NVS use as well as the effectiveness of measures implemented to reduce them.
Methods: CLABSI rates were followed from baseline prior to NVS use (3/07 through 2/08), during NVS use (3/08 through 8/08), and after measures to reduce rates with NVS use (9/08 through 8/09). Of note, our hospital has been using the Institute for Healthcare Improvement insertion bundle for CLABSI prevention since 2007. Measures to reduce CLABSI rates after NVS use began included: weekly meetings of a zero BSI task force, analysis of potential factors contributing to CLABSI rates, as well as development and staged rollout of a CLMB. Major elements of the CLMB included: hand hygiene prior to access, mask use while line is open, standardized access disinfection, standardized dressing changes, and IV tubing and injection cap care. CLABSI rates for the three time periods were compared using chi-square analysis.
Results: The baseline housewide CLABSI rate for 12 months prior to NVS use was 4.45 per 1000 catheter days. This significantly increased over the first 6 months of NVS use to 6.41 per 1000 catheter days (OR 2.23, 95%CI 1.85-2.68, p<0.0001). In the 12 months after adopting the CLMB, the CLABSI rate significantly decreased to 3.57 per 1000 catheter days (OR 0.31, 95%CI 0.26-0.37, p<0.0001 compared to NVS use without the CLMB and OR 0.69, 95%CI 0.58-0.83, p<0.0001 compared to baseline). Compared to the NVS use period, after adopting the CLMB, we observed significant CLABSI rate decreases throughout the pediatric hospital (OR 0.50, 95%CI 0.42-0.61, p<0.0001), in non-ICU adult wards (OR 0.09, 95%CI 0.07-0.12, p<0.0001), as well as in adult ICUs (OR 0.39, 95%CI 0.32-0.48, p<0.0001). Among units where the CLMB has been in use the longest (two ICUs and two general wards), only 1 CLABSI has occurred (rate of 0.45 per 1000 catheter days) in the final three months of this analysis.
Conclusions: We observed a significant increase in the housewide CLABSI rate associated with NVS use; however, we successfully implemented a CLMB focusing on a standardized technique for line access as well as the general care of the line, and this was associated with a significant decrease in the CLABSI rate, which fell significantly below baseline. Future study of other institutions employing the use of a standardized CLMB would add valuable information regarding CLABSI prevention.