806 - Decreasing Central Line-associated Bloodstream Infections Through Quality Improvement Initiative on a High Acuity Transplant Unit

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Co-Author(s)

KI

Katie Ip

Nurse Manager
Mount Sinai Hospital
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Presenting Author(s)

LS

Leah M. Shayer

Infection Preventionist
Mount Sinai Hospital
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

sl

susan m. lerner

Associate Professor of Surgery
mount sinai hospital
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LK

Leona Kim-Schluger

Associate Director of The Recanati/Miller Transplantation Institute
Mount Sinai Hospital
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JM

Jang Moon

Associate Professor of Surgery
Icahn School of Medicine at Mount Sinai, New York, NY, USA
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Central line-associated blood stream infections (CLABSI) have a significant impact on mortality, morbidity and length of stay. Data collected by the Infection Prevention Department revealed progressive increases in the rate of CLABSI on an Abdominal Transplant Unit. Recognizing a drift from best practice, front line staff, the IP team and vascular access specialists, collaborated to identify opportunities for improving care of patients with vascular access devices.

Methods: An increase in CLABSI rate was observed on the Abdominal Transplant Unit beginning in 2016. An initiative began in 2017 to evaluate whether CLABSI rate reduction was sustainable for at least 1 year and to identify key determinants of this sustainability. Interventions were aimed at infection prevention best practices, care standardization, and team-based monitoring. Interventions included (1) re-education on CLABSI reduction, (2) two RN dressing changes to validate practice during central line dressing change, (3) blood draws from central lines (during non-emergent situations) had to be approved by nurse manager, physician lead and transplant quality physician, (4) CLABSI prevention nurses were chosen as designated phlebotomists for patients with prior approval, (5) daily line review was performed to address line days, indication of line (remove latent lines) and plan of care (transition to permanent access) and this information was shared with the unit physician lead and transplant quality team. Assuring compliance with audits and timely feedback with clinician accountability were vital with compliance with best practices.

Results:

Year	Number of Infections	Infection Rate
2017 (Interventions started 4th quarter)	11	4.825
2018	9	3.294
2019	4	1.533
2020 (Quarter 1-2)	0	0

Conclusion: During the intervention, CLABSI infection rates dropped from 4.825 to 1.533 in 1,000 CVC days. The sustainability plan for this program is to continue line audits, assessing line necessity and review the effectiveness of the initiatives, review all new CLABSI data with staff and implement new changes as necessary. Joint, ongoing multidisciplinary collaboration is essential to reduce CLABSIs and optimize quality in a challenging, high-acuity patient population.