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470 Reduction of Catheter-Related Bloodstream Infections (CR-BSIs) in a Coronary Care Unit (CCU)

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Sheila A. Vereen, RN, BSN, CIC , Duke University Medical Center, Durham, NC
Rosemarie V. Brangle, MSN, RN , Duke University Medical Center, Durham, NC
Rebecca W. Johnson, RN, BS , Duke University Medical Center, Durham, NC
Deverick Anderson, MD, MPH , Duke University Medical Center, Durham, NC
Daniel J. Sexton, MD, FACP , Duke University Medical Center, Durham, NC
Becky A. Miller, MD , Duke University Medical Center, Durham, NC
Rebekah W. Moehring, MD , Duke University Medical Center, Durham, NC
Luke F. Chen, MBBS, FRACP , Duke University Medical Center, Durham, NC

Background:

CR-BSIs are associated with significant morbidity, mortality and suffering. Furthermore, the Centers for Medicare and Medicaid (CMS) Services will no longer reimburse costs for healthcare-related CR-BSIs. Thus, the prevention of CR-BSIs has never been more important or crucial to the healthcare system.

Objective:  

We aimed 1). To determine the incidence of CR-BSI and 2). To reduce the rate of CR-BSIs in a 16 bed tertiary-care CCU with a novel prevention campaign.

Methods:

We initiated a CR-BSI reduction program between physicians and nurses in the CCU, Infection Control (IC), the Bloodstream Infection Committee (BSI), and Performance Services (PS) in fall 2008. The program consisted of rapid tracking of CR-BSIs and a prevention campaign. CR-BSIs were identified by IC and rapidly transmitted  to PS for web-based tracking. Simultaneously, CCU physicians and nurses were notified by email. The number of days since last CR-BSI Rate of BSIs was tracked and displayed in the CCU.  An innovative prevention campaign was also instituted and it aimed to improve 1). Hand hygiene, 2) Adherence to Central Venous Catheter (CVC) bundle and 3) Culture of Safety in CCU. This program consisted of 1). Intensified education to staff in CCU, 2) Use of a mini-Root Cause Analysis to identify factors that contributed to a CR-BSI and 3). Use of a game to motivate improvement in hand hygiene – a bottle of hand sanitizer is custom made into a necklace and worn by the CCU attending at start of the day. The “shame necklace” passed from one CCU staff to the next found non-compliant to HH. The game improved the culture of safety within the CCU.

CR-BSIs were identified using standard definitions. Hypothesis testing was performed with Student's t-test. .

Results:  

The mean annual rate of CR-BSI prior to institution of the collaborative was 4.4, 3.7 and 4.8 per 1000 catheter days in 2006-2008 respectively. Following the prevention program, the rate of CR-BSI dropped to 0.8 per 1000 catheter days. The mean rate of CR-BSI in the pre-intervention and post-intervention periods were 4.3 and 0.8 infection per 1000 catheter days, p= 0.03.  

Conclusions:  

Collaboration, timely feedback of data, education and the use of new technology all helped to dramatically decrease CR-BSI rates in the CCU.