Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle

Wei, Abraham; Markert, Ronald J.; Connelly, Christopher R.; Polenakovik, Hari

doi:10.1177/17571774211012471

Cited by 9 publications

(6 citation statements)

References 27 publications

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“…Our process measures of using CL insertion checklists and use of capped lumens both have shown previous success and good uptake locally 22–25 . During our implementation, some limitations to adoption were noted.…”

Section: Discussionmentioning

confidence: 97%

“…Our process measures of using CL insertion checklists and use of capped lumens both have shown previous success and good uptake locally. [22][23][24][25] During our implementation, some limitations to adoption were noted. Given COVID-related staffing shortages, increased locum physician presence may not have received the same training as the regular physicians.…”

Section: Discussionmentioning

confidence: 99%

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A Quality Improvement Initiative to Decrease Central Line–Associated Bloodstream Infections During the COVID-19 Pandemic: A “Zero Harm” Approach

et al. 2023

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Introduction Central line–associated bloodstream infections (CLABSIs) are associated with significant patient harm and health care costs. Central line–associated bloodstream infections are preventable through quality improvement initiatives. The COVID-19 pandemic has caused many challenges to these initiatives. Our community health system in Ontario, Canada, had a baseline rate of 4.62 per 1000 line days during the baseline period. Objectives Our aim was to reduce CLABSIs by 25% by 2023. Methods An interprofessional quality aim committee performed a root cause analysis to identify areas for improvement. Change ideas included improving governance and accountability, education and training, standardizing insertion and maintenance processes, updating equipment, improving data and reporting, and creating a culture of safety. Interventions occurred over 4 Plan-Do-Study-Act cycles. The outcome was CLABSI rate per 1000 central lines: process measures were rate of central line insertion checklists used and central line capped lumens used, and balancing measure was the number of CLABSI readmissions to the critical care unit within 30 days. Results Central line–associated bloodstream infections decreased over 4 Plan-Do-Study-Act cycles from a baseline rate of 4.62 (July 2019–February 2020) to 2.34 (December 2021–May 2022) per 1000 line days (51%). The rate of central line insertion checklists used increased from 22.8% to 56.9%, and central line capped lumens used increased from 72% to 94.3%. Mean CLABSI readmissions within 30 days decreased from 1.49 to 0.1798. Conclusions Our multidisciplinary quality improvement interventions reduced CLABSIs by 51% across a health system during the COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

A Quality Improvement Initiative to Decrease Central Line–Associated Bloodstream Infections During the COVID-19 Pandemic: A “Zero Harm” Approach

et al. 2023

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“…This outcome is consistent with a similar outcome from other publications for the performance improvement projects conducted in ICUs and non-ICUs. [ 14 – 16 ]…”

Section: Discussionmentioning

confidence: 99%

Reducing Central-Line–Associated Bloodstream Infections (CLABSI): An Improvement Project in a Specialized Tertiary Hospital

Mostafa

Alnafee

Shanqiti

et al. 2022

Global Journal on Quality and Safety in Healthcare

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Introduction Central-line–associated bloodstream infections (CLABSI) are preventable hospital-acquired infections that harm and prolong a patient's hospital stay and increase unnecessary hospital expenditure. In collaboration with infection control and hospital epidemiology, the quality management department initiated a performance improvement project to address 144 CLABSI events in 2017. Methods The performance improvement project team used brainstorming to create change ideas presented in a driver diagram. The team then applied plan-do-study-act (PDSA) cycles to implement and monitor the improvements. Finally, the team applied a bundle of interventions that included the following: (a) policies and procedures for central line insertion, maintenance and removal processes standardization, (b) physicians training for line insertion by simulation, (c) an awareness campaign that included recognizing healthcare workers and enhancing patient engagement, (d) performing root cause analysis for the CLABSI events, and (e) automation of central line insertion, and (f) maintenance bundles documentation in the hospital information system. Results The CLABSI rate per 1000 patient days dropped from 1.5 per 1000 device days to 1.03 per 1000 device days. In addition, CLABSI events reduction was 24% by 2018. Then further reduction of 15% occurred by the end of 2019. Thus, the overall decrease in CLABSI events was 35% from the baseline number of events (i.e., 144 events) in 2017. Another achievement of the project is that 10 units reported zero CLABSI events in 2018 and 2019, of which four units had a high central line utilization rate, more than 40%. Conclusion The implemented interventions effectively reduced the CLABSI events in the hospital. The project team will continue implementing more interventions with monitoring, aiming to achieve zero CLABSIs over time in all the hospital units.

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“…14 Recent evidence also shows that standardization of the day of the week for central line dressing changes plays a role in decreasing CLABSI rates. 15 Based on this evidence, Central Line Sunday was initiated in the CTICU to align with the hospital's policy regarding central line dressing changes. Therefore, nurses changed all central line dressings on Sundays, even if that day was less than seven days from the previous central line dressing change.…”

Section: Methodsmentioning

confidence: 99%

“…This allowed for the evidence-based standardization of central line care and its proper documentation 14. Recent evidence also shows that standardization of the day of the week for central line dressing changes plays a role in decreasing CLABSI rates 15. Based on this evidence, Central Line Sunday was initiated in the CTICU to align with the hospital's policy regarding central line dressing changes.…”

Section: Methodsmentioning

confidence: 99%

Reducing CLABSIs in an Adult Cardiothoracic ICU

Orozco-Santana

Fowlds

Tamayo

et al. 2023

AJN, American Journal of Nursing

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Local problem: Central line-associated bloodstream infections (CLABSIs) are associated with increased mortality and costs. In the cardiothoracic ICU (CTICU) of an academic medical center, nine CLABSIs occurred in fiscal year (FY) 2018.Purpose: The aim of this project was to reduce the CLABSI rate in the CTICU and sustain the results. Methods: Nurse residents on the CTICU initiated a quality improvement project with a single intervention and expanded it into an ongoing initiative with additional interventions by the unit-based performance improvement committee. Evidence-based interventions were identified and implemented, including education; rounding; auditing; and other unit-specific interventions, which included "Central Line Sunday, " accountability emails, and a blood culture algorithm with a tip sheet.Results: CLABSI incidence was reduced from nine in FY 2018 to one in each of the subsequent FYs (2019 and 2020), which had similar totals of central line days, and two in FY 2021, which had a slightly higher number of central line days. The CTICU was able to achieve zero CLABSIs from August 2019 through November 2020, more than 365 days.Conclusions: Coupled with strong support from nursing leadership, nurses on the unit successfully reduced CLABSIs by adopting novel, evidence-based strategies; ongoing monitoring; and multiple interventions.

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Reduction of central line-associated bloodstream infections in a large acute care hospital in Midwest United States following implementation of a comprehensive central line insertion and maintenance bundle

Cited by 9 publications

References 27 publications

A Quality Improvement Initiative to Decrease Central Line–Associated Bloodstream Infections During the COVID-19 Pandemic: A “Zero Harm” Approach

A Quality Improvement Initiative to Decrease Central Line–Associated Bloodstream Infections During the COVID-19 Pandemic: A “Zero Harm” Approach

Reducing Central-Line–Associated Bloodstream Infections (CLABSI): An Improvement Project in a Specialized Tertiary Hospital

Reducing CLABSIs in an Adult Cardiothoracic ICU

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