According to CDC, each Central line associated bloodstream infections (CLABSI) accounts for nearly $16,550 additional health care expense per year. Long term health care facilities (LTACHs) have a high rate of CLABSI; this demands for an enhanced surveillance drive solely for these facilities. Various strategies by several federal organizations including the Centers for Medicare and Medicaid Services (CMS) Long Term Care Hospital Quality reporting Program have been introduced with the aim to reduce the CLABSI incidence among LTACHs. But the lack of leadership professional with adequate infection control expertise poses significant challenge to implement these strategies. This study presents a successful reduction in CLABSI rate in LTACHs through a dynamic approach.
Surveillance for CLABSIs and antibiotic stewardship was conducted by a multidisciplinary team consisting of an infection disease consultant, pharmacist, medical students and registered nurse at a 77 bed LTACH in Greater Detroit area from January 2015 to February 2016. From July 2015 to November 2015, weekly 2-in-1 device and antibiotic stewardship rounds included PICC line review (contaminated devices increase CLABSI rate) and appropriate antibiotic usage. The rates of CLABSIs and percentage of most commonly used antibiotics were compared before and after our intervention.
During the pre-intervention period (January to July 2015), CLABSI rate was 1.52/1000 Central line days (Figure 1). The average CLABSI rates dropped immediately after starting rounds (December 2015-February 2016) to 0.37 (p = 0.016). Similarly, average vancomycin usage decreased by 14% and daptomycin decreased by 10% after intervention (Figure 2).
This study demonstrates a simple and workable 2-in-1 approach towards both infection control and antibiotic stewardship program in a LTACH led by an Infectious Diseases physician. Further studies are needed to measure improved patient outcomes resulting from this program.
Figure 1. CLABSI rate decreased due to intervention (p=0.016).
Figure 2. Vancomycin usage (red) decreased from 73% to 63% (p ≤ 0.5), daptomycin (yellow) decreased from 19% to 9% (p ≤ 0.5) due to intervention.
A. Krishna, None
J. Kacir, None
T. Chopra, None
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