Maintenance of reduction in central line associated bloodstream infection (CLABSI) rates for seven years

Background: 
Many healthcare organizations remain focused on reducing CLABSI rates for
several reasons: 1) the high morbidity and mortality, 2) public reporting
of CLABSI rates, and 3) soon the institutions will have to bear the expense
of treating these cases. In 2002, the Johns Hopkins Hospital began an
intervention to reduce CLABSI.
Objective: 
To maintain and further reduce CLABSI rates from a successful educational
campaign, evidence based interventions, novel feedback of data and
leadership support.
Methods: 
CLA-BSIs are identified prospectively with 100% chart review by Infection
Preventionists. Definitions and rates of CLABSIs were calculated in
2001 – 2007 using NNIS standardized methodology. The NHSN definition was
used beginning in 2006. In 2002, evidence based practices including hand
hygiene, use of central lines only when indicated, use of chlorhexidine
gluconate (CHG) as the skin prep of choice, use of maximal barrier
precautions during central line placement, and use of the subclavian site
as the preferred site were implemented in 6 adult ICUs in a 1,000 bed
urban hospital. All nurses and residents in ICUs were educated. Other
interventions included identifying a unit champion, didactic lectures
given by a physician with pre- and post-tests, educational posters,
placement of bundled insertion supplies in a dedicated cart,
implementation of a nursing CVC insertion checklist, and active response
to eliminating barriers to the use of best practices. Surveillance for
CLABSIs is ongoing. Rates are shared with the ICUs. From 12/2004-12/2005
and again from 10/2008-02/2009 daily bathing with CHG was instituted in 2
ICUs.
Results: 
We reduced the CLABSI rate from the high in 2001 of 8.50 CLABSIs per 1000
catheter days to 1.05 in 2009, giving an 87.6% overall decrease in the
CLABSI rate. While there was an increased rate to 2.73 in 2006,
re-education of staff and a renewed focus helped to lower the rate.
Conclusions: 
To maintain a reduction in CLABSI rates, we found that it is necessary
to keep staff engaged in the process and the outcomes. We used
re-education period in units with an upturn in CLABSI rates, 2 separate
projects involving daily bathing with CHG in 2 ICUs, and a hospital-wide
hand hygiene initiative, together with monthly feedback of CLABSI rates
to the units.