Momentous Interventions Associated With a Decrease Of Central Line Associated Bloodstream Infections (CLABSIs) at Five Long Term Acute Care Facilities

Background:

The advancement of modern medicine has been enhanced, in part, by the extensive use of invasive medical devices, including intravenous (IV) catheters. Nonetheless, IV catheters are frequently associated with serious complications, such as Central Line Associated Bloodstream Infections (CLABSIs). In effect, CLABSIs are considered one of the most frequently encountered hospital acquired infections, leading to increased risks of patient morbidity and mortality.

It’s estimated that 7 million central venous catheters will be inserted annually in the United States. Even with the best available aseptic techniques utilized during insertion and maintenance of the catheter, an estimated 248,000 bloodstream infections will occur within the United States alone each year. The mortality rate of CLABSI in critically ill patients may approach 25%.  Each episode of CLABSI will cost $30,000-$56,000 per survivor and result an additional average stay of 6.5 days in the ICU.

Empirically conceived interventions are known to prevent many of these infections; yet only a few individual and multicenter studies have demonstrated that the incidence of CLABSIs can be reduced with implementation of systematic and sustained interventions. 

Objective:

To review the successful CLABSI reduction procedures implemented at five different Long Term Acute Care facilities (LTAC), allowing for a better understanding of quality improvement strategies that are sustainable within a healthcare organization.

Methods:

A multicenter retrospective time series study was conducted to compare CLABSI rates before and after intervention periods at five LTAC facilities. Participating facilities were alike in their desire to implement interventions to assist in CLABSI prevention but different in facility size and geographic location. Quarterly meetings were held with program leaders from each of the five facilities to review results and practices/products implemented. Data from all facilities were aggregated to calculate pooled mean CLABSI rates. Statistical modeling was used to compare infection rates before intervention, after intervention, and for the sustained intervention periods.

Results:

Before the intervention, the median rate of CLABSI was 2.86 per 1000 catheter days in these facilities.  After the implementation of a clear, swabable, positive displacement connector within the organizations, the median rate dropped to .46 per 1000 catheter days, representing an 84% reduction in the CLABSI rate.

Conclusions:

The implementation of evidence based interventions, both practice and device related, resulted in a large and sustained reduction in CLABSI rates in these five LTAC facilities. The implementation of a clear, swabable, positive displacement connector significantly contributed to decreasing CLABSI rates by 84%.