A Multidisciplinary Approach to Reduction of Central Line Associated Bacteremia in Non-ICU Patients
Methods: A multidisciplinary team was formed to identify gaps in existing data and practice using an A3 Process Mapping tool. The following 6 improvement opportunities were identified: utilize electronic information systems to facilitate measurement of central line (CL) days and CLABSI rates on all non-ICU wards; identify best practices for care of SS and HD patients; revise staff communication policies; promote the use of a CL order set; monitor staff compliance with CL care protocols; and develop a patient education brochure describing risks and care of CL. Changes were implemented in March 2012. Non-ICU CLABSI rates and CL utilization ratios were measured before and after the interventions. Rates of CLABSI among HD and sickle cell patients were compared. A two-sample z test was used to measure statistical significance.
Results: The CLABSI rate for all non-ICU patients decreased from 0.60/1000 CL days in 2012 to 0.42/1000 CL days in 2013 (p=0.43). The CL utilization ratio in non-ICU patients decreased from 0.30 in 2012 to 0.21 in 2013 (p<0.001). Non-ICU CLABSIs accounted for 83% (15/18) of all CLABSIs at BMC during 2012, and 43.7% (7/16) in 2013 (p=0.016). One third of the non-ICU CLABSIs in 2012 occurred in HD and sickle cell patients but no CLABSIs occurred in these groups in 2013 (p=0.08).
Conclusion: Involving key stakeholders to define, document, analyze, prioritize, recommend, and implement solutions resulted in a reduction in the rate of CLABSI, improvement in patient care, and reduction in cost. Hospital-wide dissemination of compliance rates and increased education has also contributed to a decline in rates. Efforts continue to improve compliance with use of the central line order set.
S. Ghai, None
C. Hill, None
M. Fura, None
E. Stephenson, None
C. Sulis, None
G. Garvin, None
M. Grande, None
N. Bhadelia, None