Patient Care Operations Manager Ann and Robert H. Lurie Children's Hospital of Chicago Chicago, Illinois, United States
Abstract: Central Line Associated Bloodstream Infections (CLABSIs) are associated with increased morbidity and mortality in ICU patients, prolonged hospital stays and greater healthcare costs. Despite participation in hospital-wide CLABSI prevention initiatives, the Cardiac Care Unit (CCU) experienced an increase in CLABSI rates in the beginning of fiscal year 2022.
The project aim is to decrease the CCU’s standardized infection ratio (SIR), the measure of observed infections over the number of expected infections, over a 12-month period from a peak of 1.64 to 0.75 by August 31, 2022.
A multi-disciplinary team convened to develop a unit-specific approach to CLABSI prevention. As a quality improvement project, Plan-Do-Study-Act cycles were used to implement and evaluate CLABSI reduction measures. The interventions targeted the following areas:
Weekly Central Line Rounds performed by provider and nurse CLABSI champions to identify and intervene on central line risk factors for infections: Interventions included use of antimicrobial locks when appropriate, increased barrier protection to the line, opportunities for line removal or exchange in the setting of malfunction, and escalation of skin and dressing-related concerns
Increasing maintenance bundle observations with in-the-moment intervention and education
Collaboration with the institutional Infection Prevention and Control team to increase environmental hygiene: Auditing of high-touch surface disinfection
Practice change to use of heparinized fluids from heparin-locking central lines to decrease line accesses
Results: Although the CCU has not yet achieved our SIR goal of 0.75, there is a trend toward improvement with a decrease in SIR to 1.18. In July of 2022, the CCU celebrated 127 days without a CLABSI, its longest CLABSI-free stretch since August 2021.
Conclusion: A multidisciplinary and multipronged approach to CLABSI reduction spearheaded by local unit champions has proven to be an effective measure toward decreasing the CLABSI rate in an acuity-adaptable cardiac care unit.
