The impact of implementing a multifaceted Vascular Access Management (VAM) bundled approach to reduce central line-associated blood stream infection (CLABSI); process and products to reduce CLABSI rates in adult and neonatal populations

Background: Appropriate central venous catheter (CVC) maintenance is critical to CLABSI prevention.  At Detroit Medical Center (DMC), multidisciplinary experts developed a strategic plan to prevent CLABSIs. 

 

Methods:

The DMC has > 2000 beds, 4 levels 3 & 4 NICUs, 2 level 1 trauma centers, 3 dialysis centers, and a burn unit.  In 4/15 the VAM program was implemented addressing CLABSI prevention via multiple avenues, including unit-based rounding, product evaluation and data feedback. Rounding sessions led by the Vascular Access Team and Infection Prevention, focused on CVC maintenance, appropriate CVC indications, chlorhexidine bathing and dressing integrity.  Products evaluated included dressings and alcohol impregnated caps (AICs).  Feedback of CLABSI data occurred at all organizational levels from front line staff to executive leadership.  CLABSI rates were prospectively surveyed by Infection Prevention.  Fifteen months (5 calendar quarters (Q)) of CLABSI data (1/15-3/16) was analyzed.  CLABSI rates were compared in the pre-VAM implementation period (1/15-3/15, Q1), the early post-VAM implementation period (7/15-9/15, Q3) and the late post-VAM implementation period (1/16-3/16, Q5).  

Results:

From 1/15-3/16, there were 80 CLABSIs and 60,127 CVC days (1.33 CLABSI/1000 CVC days).   Among adult patients, there was a progressive decrease in CLABSI rates, from the pre-VAM implementation (Q1, 1.72 /1000 CVC days) to the early post-VAM implementation period (Q3, 1.18/1,000 CVC days) to the late post-implementation period (Q5, 0.8/1,000 CVC days)) (p=0.06).  Among adult non-ICU patients, the CLABSI reduction between pre-VAM (Q1) and late post-VAM (Q5) implementation periods was significant (2.08 and 0.75/1000 CVC days, (p=0.04) (Figure 1).

In NICUs, there was no change in CLABSI rates from the pre-VAM implementation (Q1, 2.38) to early post-VAM implementation period (Q3). (2.42) (Figure 2).  At the beginning of Q4, AICs were implemented in NICUs.  By the late post-VAM implementation period (Q5) there was a notable decrease in CLABSI rates (0.4/1,000 CVC days) (Q3 vs Q5 p=0.06). 

Conclusion:

The multifaceted VAM program had a significant impact on CLABSI rates in non-ICU adult patients.  The addition of AICs to the VAM program led to CLABSI reduction in NICUs.