192. Use of Disinfection Caps on All Central Line Access Ports is Associated with Improved Patient Safety Through Substantial Reduction in CLABSI Rates, and Potential Substantial Savings in Healthcare Costs
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C

Background:   Central line associated blood stream infections (CLABSI) are risks to patient safety increasing morbidity, mortality, length of stay and cost of medical care.  One source of CLABSI is contamination and colonization by microorganisms spreading from the extraluminal surface to the intraluminal surface of the catheter access port. Thus, if ports were better disinfected before and after each use, and protected from touch/surface contamination, CLABSI rates should fall. The routine application of single use 70% isopropyl alcohol (IPA) containing disinfection devices that attach to access ports may decrease contamination of the ports and subsequent CLABSIs. 

Methods:   This is a single center 1 year pre-post observational study examining CLABSI rates for adult units during an 8 month standard care period vs a 4 month period when the use of IPA impregnated disinfection caps on all ports on all central lines became standard practice. Two ICUs were excluded because they had served as the pilot units for an earlier ongoing disinfection device study. Findings were then extrapolated to determine potential impacts for a full year.

Results:   Hospital wide CLABSI rates decreased 63% (p=0.004) with this intervention. ICU CLABSI rates decreased 62% (from 0.21/1000 catheter days to 0.08/1000). Non-ICU floor units CLABSI rates decrease 100% (1.65/1000 to 0.00/1000) (Figure 1). We observed 11 fewer CLABSIs during the 4 month intervention period, than would have been expected had usual care continued. Extrapolating these data, over the course of a full year 33 CLABSIs might be prevented (12 CLABSI in ICUs, and 21 CLABSI amongst non-ICU units). Using CDC estimates of healthcare cost of $29,166 per bloodstream infection, preventing 33 CLABSI would reduce costs $962,478 over the course of one year.

Conclusion:  We noted an immediate, widespread and substantial decrease in CLABSI rates at our institution after the routine use of disinfection devices on all central line access ports. CLABSI rates declined in every ICU and every non-ICU unit. Eleven fewer CLABSI were observed in the 4 month period, which extrapolated over 1 year corresponds to 33 fewer CLABSIs, substantial improvement in patient safety and, potentially, nearly a million dollars in reduced excess healthcare costs.

Jorge P Parada, MD, MPH, Infectious Diseases - Infection Control, Loyola University Chicago, Maywood, IL, Alexander Tomich, RN DNP, Infection Control, Loyola University Chicago, Maywood, IL and Xolani Mdluli, MD, Infectious Diseases, Loyola University Medical Center, Maywood, IL

Disclosures:

J. P. Parada, None

A. Tomich, None

X. Mdluli, None

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