Mount Sinai is a 1,170 bed tertiary care teaching facility in New York City. Since the inception of the CLABSI Committee in 2005, adult intensive care unit (ICU) CLABSIs, have decreased 75%. Recognizing that prevention initiatives must extend beyond the ICU population, a interdisciplinary team collaborated on an institutional approach to CLABSI reduction. The Define, Measure, Analyze, Improve and Control (DMAIC) model is being used to further diminish variability and CLABSIs.
Process improvement techniques including direct observation, process mapping and checklists were used to assess workflow compliance with the CLABSI insertion bundle (line necessity, sterility on insertion, use of alcohol impregnated ports, dressing change technique, and hand hygiene practices). Feedback was provided through just-in-time coaching with clinicians, meetings with senior leaders, affinity diagrams, and run and control charts. 10 line insertions and 3 distinct insertion teams made up of attending physicians, fellows and nurses were observed. The insertion procedures focused on hand hygiene sterile technique and spatial assessments of the dedicated location for line insertion.
The maintenance bundle was assessed on 4 of the 6 units – units were selected for their variable patient populations and infection rates. 75 lines were observed over a 2 month period. The maintenance assessment observed the condition of the line, type of dressing used, date on the dressing, labeling of tubing and IV bags, and the capping of ports.
Over the 18 months from the start of the program (July 2013 to December 2014), CLABSIs were reduced by a total of 76% (from 2.18 to 0.525 per 1000 line days [95% CI 0.962-2.354, p=<.05]).
During the study period, compliance with the CLABSI maintenance bundle increased by from 60% to 95%. Adopting the Just in time coaching methodology during observations of the insertion bundle resulted in 98% compliance.
Our collaborative approach aligns the efforts of key stakeholders, including clinicians, administrators, and ancillary staff. Our success with CLABSI reduction transcends different in-patient units which have varying practices and cultures, including both ICU and non-ICU settings. The use of DMAIC facilitates continuous, sustainable improvement in CLABSI reduction.
S. Ceresoli, None
R. Kohli-Seth, None
F. Wallach, None