Three Years Experience of Central Line Associated Bloodstream Infections in the Intensive Care Units and Blood and Marrow Transplant Unit at an Academic Medical Center

Background: Bloodstream infection (BSI) is the most common infection in Intensive Care Units (ICUs); most of them are central venous catheter (CVC) related. Compliance with the Institute for Healthcare Improvement (IHI) bundles, adherence to hand hygiene guidelines, application of evidence-based findings and teamwork are crucial in the chase for zero infections.

Objective: To describe the interventions taken that led to the success of the improvement in central line associated bloodstream infections (CLABSIs) in the Pediatric and Adult intensive care units, and the Blood and Marrow Transplant Unit

Methods: Retrospective and Prospective study from Jan 2003 to Oct 2010 in the Pediatric and Adult Intensive Care Units and the Blood and Marrow Transplant Unit. Several interventions occurred between 2007- 2010 to reduce our CLABSIs: insertion of central lines was conducted in compliance with the IHI Central Line Bundle; hand hygiene observations were conducted by nursing units and the Infection Prevention Department; a luer access device (LAD) was re-introduced to the facility, and in 2010 the clear version of the LAD was adapted; in 2008 we began the use of silver and chlorhexidine coated catheters; upon identification of a CLABSI, the management of the nursing units was notified, and a root cause analysis of the CLABSI was submitted to the Infection Prevention Department within seven days; monthly meetings of the Hospital Acquired Infections (HAI) Task Force included discussion about challenges and success measures in Chasing Zero Infections.

Results: The rate of catheter related blood stream infections show a 43% rate improvement (4.49 infections per 1000 central line catheter days between 2003 and 2007, to 2.54 infections per 1000 central line days between 2008 and October 2010). Our rates have consistently improved since 2007, and our staff is taking an active part in preventing CLABSIs.

Conclusions:
Our CLABSI rates show consistent improvement after: 1) continued compliance with IHI Central Line Bundle, 2) continued compliance with hand hygiene, 3) reintroduction of the original LAD to the institution, 4) adopting new products based on evidence based publications like silver/chlorhexidine coated central venous catheters upon market availability, 5) staff accountability in identifying opportunities for improvement when a CLABSI is identified, and 6) communication with nursing units through monthly meetings.