In Search of Zero:Eight Years of Interventions Lead to Reduced Central Line Associated Bloodstream Infection Rates

Background:

Improved patient care and satisfaction are by-products of a successful CLABSI Reduction Program. Some estimates suggest that one in every ten patients with a central venous catheter will develop a catheter related bloodstream infection. For the patient, this is a serious complication causing longer hospitalization, increased exposure to antibiotics, and significantly higher morbidity and mortality. In 2001, a 51-bed Long Term Acute Care Hospital undertook an eight year journey to decrease their CLABSI rates in order to improve patient outcomes.

Objective:

To utilize currently available technology to reduce CLABSI to lowest possible rate and to sustain the reduction.

Methods:

This study was conducted as a prospective observational time series study. In 2000 the CLABSI rate at this LTACH was higher than the national benchmark. To reduce the CLABSI rate, several interventions were implemented at various time intervals and CLABSI rates were collected. Prospective BSI surveillance and case finding was the responsibility of the Infection Preventionist. Infection rates were tracked monthly using the National Healthcare Safety Network (NHSN) definitions. 

Results:

Interventions implemented in 2001 included CHG eluting discs, CHG alcohol prep swabs, hand hygiene education and introduction of an alcohol based hand gel. By the end of 2001 the rate was below the national benchmark. In 2002, manufactured catheter securement devices were implemented. In 2002, infection rates dropped and again were below the national benchmark. In 2005 the facility experienced an increase in CLABSI rates. This was attributed to the increased use of Agency Nurses. In 2006 this practice was discontinued and a continuous education program required of all core nursing staff became a keystone of the CLABSI reduction program. In 2007 a trial of new IV pumps which introduced a new needleless access device was temporally associated with a CLABSI rate increase. In April 2008 the facility switched to a clear, swabable, positive displacement needleless access device. The rate for the last nine months of 2008 ,while the device was in use, decreased to 1.18 per 1,000 catheter days. A cost savings was realized due to a reduction in replaced lines, a reduction in contaminated blood cultures, and a decrease in the actual number of blood cultures being done. A cost savings due to a significant reduction in the use of alteplase, used for treating occlusions, was also realized.

Conclusions:

Most devices will initially lead to short term results. The value of any intervention to an effective CLABSI reduction program is a sustainable positive result. With the clear, positive displacement swabable connector in place for sixteen months the results have proven to be sustainable. As of the end of July 2009, the CLABSI rate at this facility was 0.98 per thousand central line days.