CR-BSI Rates Sustained At Zero For 24 Months Utilizing KISS Principle - Minor Process Changes Lead to Sustained Improvement

Background: In August 2007 the CR-BSI rate in the Adult Medical/Surgical ICU reached a peak of greater than 5 CR BSIs per 1000 catheter days. This peak was more than twice the pooled mean CR-BSI rate of 2.2 per 1,000 catheter days reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network System in 2006. This peak occurred despite multiple CR-BSI prevention measures introduced as part of a bundled initiative in 2007. Infection Prevention responded to the peak by making simple adjustments to the current process, providing education, and involving frontline staff feedback in the process changes. Subsequently the CR-BSI rate promptly decreased to 0 CR-BSI in the ICU setting and has been sustained for 24 months. Objective: The purpose of this study was to evaluate the impact of product, process and procedure as part of a multi-pronged but simple approach to reducing CR-BSIs in the Adult Medical-Surgical Unit and the Adult Medical/Surgical ICU population. Methods: Baseline CR-BSI rates were measured in November 2007. Investigators also reviewed 24 consecutive months worth of retrospective CR-BSI data and compared rates to 24 consecutive months of CR-BSI data collected after the initiation of the CR-BSI Reduction Project. Ongoing staff education regarding the appropriate care of central line catheters, modification of the central line bundle insertion kit to include a closed luer access, split-septum device, and a slightly modified catheter flushing process were implemented in November 2007. Monthly CR-BSI rates per 1000 catheter-days for each month of the pre-and post intervention period were calculated according to the NHSN methodology and pooled for either the pre or post intervention period. Results: The mean rate of catheter-related bloodstream infections per 1000 catheter-days decreased 84% from 4.06 infections per 1,000 catheter days at baseline to 0.63 infections per 1,000 catheter days 24 months after project initiation in the Adult Medical/Surgical population. The mean rate has been sustained at 0 in the Adult Medical Surgical ICU population for 24 months post project initiation. Conclusions: Involving frontline staff in simple process changes, standardized order sets, providing continuing education, and consistently evaluating the process and procedure around central-line insertion, central line care and maintenance have resulted in a dramatic and sustained reduction in CR-BSI infections in the Adult Medical-Surgical Population and in the Adult Medical/Surgical ICU population.