188. Do No Harm Central Line Blood Stream Infections. Impact of Evidence Based Practice Improvement
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Central line associated bloodstream infections (CLABSI) are known to be serious infections that prolong hospital stay, and increase both cost and morbidity.  CLABSI prevention requires an extensive review of risk factors and a multidisciplinary approach to ensure that current evidence based practices are routinely applied by hospital staff. We describe the process by which we accomplished a sustained reduction in infections.

Methods: A 2 year retrospective review of CLABSIs  followed by a 1 year post intervention analysis was conducted at the John D Dingell VAMC, Detroit MI. Infection control data and microbiologic data were reviewed to identify CLABSI numbers, types of lines, pathogens, timing of infection in relation to line insertion, overall blood culture contamination, and primary services. Following this, a multidisciplinary (infection control, hospital leadership, education, interventional radiology, nursing, and physicians) approach was developed to establish a mechanism for CLABSI reduction and the effects analyzed. Measures utilized included literature review, updating and creation of guidelines (central line indications, line maintenance), staff in-service (line maintenance, batching and restriction of routine blood draws, and appropriate blood culture collection process), creation of gatekeepers who approved the placement of central lines, daily line rounds, implementation of new technologies, direct observations of line placements, and unit huddles immediately following a CLABSI.

Results: A total of 11 CLABSI were identified in the pre-intervention period, with 8 occurring on acute care floors. 10 of the infected line were centrally placed peripheral IV (PICL), the majority of which occurred 2 weeks or more after insertion. 7 CLABSI occurred on the medical service with coagulase negative staphylococci the predominant pathogen. In the post intervention period, there were a total of 1 CLABSI - a reduction of 90.2 % ( 1.3 to 0.1 infections per 1000 line days, p<0.001).

Conclusion: A multifaceted approach involving key hospital staff is necessary to understand the epidemiology of CLABSI, review current processes, and develop evidence based interventions to reduce infections with sustained effects.

Sorabh Dhar, MD, Marge Freundl, RN MSN, Jennifer Johnson, RN BSN, Megan Shefke, RN BSN, Thomas Lamacchia, MS PA-C, Susan Muscat, RN and Virginia Nelson, RN MSN, John D. Dingell VA Medical Center, Detroit, MI

Disclosures:

S. Dhar, None

M. Freundl, None

J. Johnson, None

M. Shefke, None

T. Lamacchia, None

S. Muscat, None

V. Nelson, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.