QAPI 125 - Utilizing a Multi-disciplinary Approach to Reduce Central Line Utilization and Subsequent Elimination of CLABSI

Background: Central Line Associated Blood Stream Infections (CLABSI) are preventable healthcare associated infections (HAI). CLABSIs can result in increased length of stay, healthcare cost, and morbidity/mortality. Between April 2021 and April 2022, it was noted that an eighty-nine percent increase in the number of CLABSIs had occurred from the previous year. A root cause analysis identified an average utilization rate of seventeen percent as a potential source for the increase in CLABSIs.

Methods: An action plan was developed using a solution filtering matrix to reduce utilization of central lines. A twice daily multidisciplinary device huddle was implemented that included the chief nursing officer, a representative from each nursing unit, infection prevention, and a vascular access specialist team (VAST) member; clinical pharmacists were consulted as needed. A goal rate of fifteen percent utilization was established. All patients with central venous access devices (CVAD) were identified and insertion date and justification were reported. VAST performed daily rounding on all patients with CVADs. The primary nurses were tasked with discussing continued need with the patient’s provider. Education was provided to bedside staff regarding the increase in CLABSI numbers and how they could impact change.

Results: Between April 2021 and April 2022 CVAD utilization was seventeen percent with a CLABSI rate of 1.83. Post-implementation showed a utilization decrease to thirteen percent with a CLABSI rate of zero.

Conclusions: Active discussion in continued necessity for CVAD, as well as frequent rounding, resulted in not only a decrease in central line utilization, but also a sustained reduction in CLABSI. Education and dialogue regarding the impact utilization can have on CLABSIs is essential to a successful CLABSI reduction program.