Reduction in Central Line-Related Bloodstream Infection as a Result of Multiple Process Improvement Changes

Background: PinnacleHealth System (PHS) is a 600-bed hospital system consisting of two acute care hospitals in South Central Pennsylvania. Baseline central line-related bloodstream infection (CLBSI) rates for the four adult critical care units indicated a need for multiple process improvement changes.

In May 2005, PHS began participation in the Institute for Healthcare Improvement (IHI) 100,000 Lives Campaign.  This campaign focused on the use of a “bundle” for the prevention of CLBSI.  The bundle includes utilization of a maximal sterile barrier during insertion, chlorhexidine skin antisepsis, proper site selection, and daily review of line necessity.  Root Cause Analyses (RCA) conducted on CLBSI showed inconsistent use of the bundle components. Since then, various interventions have been put in place to reduce the rate of CLBSI.  In July 2006, a kit that includes all necessary items for use during insertion was created to improve compliance. The Central Line Insertion Pre-Procedure Checklist and Progress Note was implemented for use during all central line insertions in October 2008.  In January 2009, the IV Team began observing all central line insertions and in addition, educated staff system-wide with the “SAVE that Line” campaign. This campaign, sponsored by the Association for Vascular Access, seeks to educate and remind all clinicians about the most important principles that must be observed when inserting, accessing or maintaining any vascular access device. The implementation of the aforementioned measures increased both awareness and compliance when inserting central lines, which in turn, resulted in a decrease in CLBSI.

Objective: To demonstrate that compliance with all of the components of a central line "bundle" decreases the infection rate.

Methods: Rates of CLBSI (per 1,000 device days) were calculated using the Centers for Disease Control and Prevention (CDC) definitions for surveillance during the pre and post-intervention time periods.

Results: The baseline CLBSI rate in the four adult critical care units was 1.8 (16/8,833) for January 2005-December 2005.  The post intervention CLBSI rate for January 2009-December 2009 was 0.4 (3/8,514) p=0.0028. The current rate for January 2010-June 2010 is 0.4 (2/4,606).

Conclusions: :  Education of staff responsible for line placement and maintenance, making items necessary for line insertion readily available in one central location, in addition to using the Pre-Procedure Checklist and direct observation of central line insertions have all contributed to a significant decrease in CLBSI.