P015 - Eliminating Central Line Associated Blood Stream Infections: An Interdisciplinary Quality Initiative Utilizing Disinfecting Caps and Dedicated Access Improvement Training

Jason Battle - Senior Clinical Specialist, Research, ICU Medical

ICU Medical

Purpose: : This improvement project sought to achieve a significant reduction (≥ 30%) in central line associated blood stream infection (CLABSI) rates by introducing a multi-faceted approach in work practices, continued vigilance and controls, in the identity of disinfecting caps (SwabCap, ICU Medical). Cost benefit was evaluated as avoided infections.

Methods: : This study was performed in two phases. During both phases, care for maintenance and care for catheter workflow included CDC recommended practices. The initial phase developed a background CLABSI rate in all the wards within the 400-bed hospital. The initial phase was from July 2019 until March 2021, with the exception of the months of April to June 2020, due to Covid.
The multi-faceted, bundled intervention phase was from April to June 2021. During the intervention phase, the disinfection caps were introduced following a general education campaign and hands on training by the manufacturer and hospital infection control. Additional cross functional training and continued education was performed by the disinfecting cap manufacturer and the hospital infection control teams. No other CLABSI initiatives were introduced during any of the study phases.
Compliance in the usage of the disinfecting caps was evaluated by random quality audits.

Results: : In the background phase of the study 25 CLABSI occurred in 133,126 patient days, including 39,271 device days. The CLABSI rate was determined to be 0.64 events per 1,000 device days.
The intervention phase saw no CLABSI events recorded in 20,589 patient days, including 6,356 device days. The CLABSI rate was determined to be 0, and the SIR 0. The rate ratio (RR) was also determined to be 0 (95% CI 0, 0.98, p-value 0.047). Compliance in the usage of the disinfecting caps was 78%.
Predicted infection, for the three months of the intervention are 2.23, 2.34, and 1.85. The intervention period saw an avoidance of six CLABSI events.
Based upon the reduction of six CLABSI ($48,108 per CLABSI event) events, the potential cost savings by implementation of the intervention is $288,648 during a three-month period alone. Extrapolated to an annual basis, this increases to $1,154,592, for the participating facility.

Limitations:: This study was performed at a single hospital, Mount Carmel East Hospital, a 400-bed hospital. The intervention period of the study was restricted to a three-month period due to the investigator relocating to a new position. Positive blood stream infection was used as a determiner of a CLABSI.

Conclusions: : Introduction of disinfecting caps and associated cross functional training, resulted in a decline in CLABSI incidence. Baseline infection rates were comparable to top quartile of national infection rates. Implementing disinfecting caps may be easy to implement and offer significant cost savings as a result of avoided infection related costs.