189. Reduction in Central Line Bloodstream Associated Infections Following Implementation of a Central Line Maintenance Bundle in Multiple Long Term Acute Care Hospitals
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Effective strategies are required for preventing and reducing hospital-acquired (HA) central line-associated bloodstream infections (CLABSIs) and have not been studied in Long Term Acute Care Hospitals (LTACHs), which specialize in extended acute care of patients with Chronic Critical Illness (CCI), a syndrome of prolonged dependence on intensive care therapies such as mechanical ventilation, for complex medical conditions.

Methods: A Central Line Maintenance Bundle (CLMB) was implemented in 31 Select Medical LTACHs.  A total of 25 LTACHs completed six months of the CLMB, which was developed from evidence-based practices (EBPs) adapted from national CDC guidelines for the prevention of infections, and included: 1) a trained central line team (CLT) of nurses who follow the regimented CLMB protocol 2) education on the CLMB protocol; and 3) periodic knowledge assessments on the EBPs of central line maintenance. Additionally, the CLMB protocol mandated the use of alcohol-based central line caps and the application of a chlorhexidine-impregnated sponge dressing.  Pre- and post- study competency was assessed with an online quiz on the CLMB protocol.  Compliance with the CLMB was assessed by each LTACH’s Nurse Director of Quality Management, who inspected every patient with a central line using a Central Line Care Competency Checklist.

Results: There was an overall significant increase in compliance to the CLMB by the CLT; compliance varied from 90.7% to 100% over the first 5 weeks of the program [Related-Samples Friedman’s Two-Way Analysis of Variance by Ranks, p<0.05].  Competency was maintained through 6 months of the study, (average score pre-test=83%; post-test=86%).  The average LTACH CLABSI rate between 6-months pre- and post-implementation of the CLMB was reduced by approximately one-third [Generalized Estimating Equation Regression; Wald Chi-Square=4.35 (df=1, p=0.037)].

Conclusion: EBPs with CDC infection prevention guidelines are effective in reducing HA CLABSI rates by approximately one-third in LTACHs.  Assuming a cost of $16,550 per HA CLABSI, results indicate an annual cost savings of approximately $1.2M for the LTACHs studied, with an associated slight decrease in mortality.

Joseph Gastaldo, MD, Antony Grigonis, PhD, Mary Burkett, RN, MS, Amanda Dawson, PhD, Arthur Dylag, MA, MBA and Lisa Snyder, MD, MPH, Select Medical, Mechanicsburg, PA


J. Gastaldo, Select Medical: Consultant, Consulting fee

A. Grigonis, Select Medical: Employee, Salary

M. Burkett, Select Medical: Employee, Salary

A. Dawson, Select Medical: Employee, Salary

A. Dylag, Select Medical: Employee, Salary

L. Snyder, Select Medical: Employee, Salary

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