• According to The Joint Commission and CDC (2019), CLABSI accounts for 1/3 or 30,100 of HAI-related death annually. In addition, bloodstream infections prolong hospitalization by an average of 7 days (IHI, 2012). • 250,000 CLABIs occur in the U.S. each year and accounts for more than $1 billion annual cost (CDC, 2018). • The estimated associated costs related to CLABSI averages $16,000 (TJC, 2018) and up to to $39,000 per episode (Infection Control and Hospital Epidemiology, 2014). Strategic Impact: Quality/Safety Service Finance BACKGROUND AND BASELINE DATA • MMC is a non-profit, 419-bed, Level 2 trauma hospital with three ICUs, providing specialty services such as cardiovascular, bariatric, orthopedics, oncology and neurosurgery. • Total of 11 CLABSI in 2018, averaging rate of 0.7 per 1000 central line days (Data Source: NHSN, 2018). • Financial impact estimated from $176,000 to $429,000 (TJC, 2018 and ICHE, 2014). PROJECT DEFINE MEASURE AND ANALYZE TEST AND IMPLEMENT ALINE VAN, R.N., MSN, CNL, CPHQ, LSSBB • CRAIG BOSCH, R.N., MSN, FNP • ROGER ELIAS, M.D. TERESA BORUNDA , R.N., CRNI VASCULAR ACCESS TEAM • MICHELE COLIN, R.N., INFECTION PREVENTION REDUCING CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTIONS (CLABSI) AIM STATEMENT To reduce the current CLABSI average rate by 50% (from 0.7 to 0.35) by December 31, 2019. MEASURES Outcome measure: Total number of CLABSI per 1,000 Central Line Catheter-days. (NHSN definition: Total # of CLABSI cases/Number of central line days x 1,000) Process Measures: – Central Line Care bundle compliance performance – Daily line assessment documentation Balancing Measures: – Midline Utilization, PIV, Device Utilization Average Rate of 0.7 per 1000 Line Days MANAGE VARIATIONS (PROCESS) • New standardized central line kits with visuals. • Identified core dressing change team (ICU and AMCU). • Maintenance bundle compliance audit and oversight. • Implement central line algorithm, discourage femoral lines. • CHG daily baths for patients with central lines on all units. • Dressing change on every 7 days on all units. Improve Work Flow (People/Practices) • Assessed physician central lines ordering practices/process and present data findings to med staff committees. • MD champion discussed line necessity with intensivists. • Using EPIC report to oversight daily line necessity by frontline leader. • RN to consult with IC team for suspicious infection before Day 3. Change the Work Environment (Resources) • VAT RN trained unit RN. Real time teaching on dressing changes and line necessity during rounding. • Managers communicate to ICU director with patient transferred to floor without lines indications. • Teaching tool to address maintenance care bundle, documentation and line necessity. Teaching during shift change huddles and floor rounding by quality staff. • Guidelines on type of lines used and appropriateness of medications/solution/duration. Focus on Products and Service (Process/Practices) • Using CHG swab to “scrub the hub”. • Change CHG wipes brand for patients’ comfort and better compliance with product usage. • Warm CHG wipes before using to increase patients’ comfort. TEST OF CHANGE AND CHANGE CONCEPTS OUTCOME AND CONTROL LEARNINGS AND CHALLENGES • New nurses brought in culture and workflow from other community hospitals and thought only the vascular access team RN does central line dressing changes. • Psych-patient management is a challenge with central lines maintenance care. • Good documentation for line management and patient medical condition helps support case review and compliance auditing. • Lack of vascular access team resources to support consistent maintenance care. • Leverage shift huddles, rounding and team support for education on new processes and documentation gaps. • Due to capacity challenges in ICU, higher acuity patients with lines being transferred to units where floor RNs are unfamiliar with central line care. Project Contact: Aline Van, Clinical Effectiveness Consultant [email protected] sutterhealth.org/mmc