Prevention of Central Line Associated Bloodstream Infections with an Electronic Medical Record Intervention

Background: In 2002, the Centers for Disease Control (CDC) and Prevention established Guidelines for the Prevention of Intravascular Catheter-Related Infections.  It is estimated that 250,000 to 500,000 central line associated bloodstream infections occur per year in the United States.  According to the CDC, the median rate of central line associated bloodstream infections (CLABSI) in Intensive Care Units (ICUs) of all types ranges from 1.8 to 5.2 per 1,000 catheter-days.¹ The National Healthcare Safety Network (NHSN) reported a pooled mean CLABSI rate of 1.5 per 1000 catheter days in both the ICUs and inpatient wards between 2006 and 2008.² The Cleveland Clinic Florida had 2.11 CLABSI per 1,000 catheter-days during 2009.  CLABSI has been associated with increased morbidity, mortality, hospital stay, and medical costs.^3-4

Objective: To determine if an electronic medical record (EMR) intervention can reduce the rate of CLABSI and/or decrease the rate of catheter-days.  

Methods: Our observational study assessed the effect of an electronic template intervention on the reduction of CLABSI and catheter-days pre-intervention and post-intervention.  The primary endpoints for the study were CLABSI and the catheter-days in the hospital.  The electronic template is based on the 2002 CDC guidelines for the prevention of intravascular catheter-related infections and it was integrated into an ICU transfer note.  The template reminds attending physicians and residents to re-evaluate the necessity of central lines, foley catheters, and pressure ulcer preventative measures, when patients are transferred from the ICU.

Results: A total of 6 episodes of CLABSI occurred during a total of 2,956 catheter-days during the 4-month pre-intervention period (January 1, 2010 until April 30, 2010). The infection rate of 1.4 per 1,000 catheter-days was calculated.  During the post-intervention period (May 1, 2010 until August 30, 2010), a total of 3 episodes of CLABSI were recorded of a total of 3,157 catheter-days.  The CLABSI rate of 1.0 per 1,000 catheter-days represents a 28.6% decline compared to pre-intervention (p = 0.72).  There was a decline in the 2009 infection rate of 2.11 per 1,000 catheter-days and 2010 infection rate of 1.15 per 1,000 catheter-days  (p = 0.18).  The median catheter-days declined 21 days from 822 catheter-days per month in 2009 to 801 catheter-days per month in 2010 (p = 0.59).

Conclusions: Our study demonstrates that the use of an EMR intervention may reduce the rates of CLABSI and catheter-days at a community-based teaching hospital.