RESEARCH POSTER PRESENTATION DESIGN © 2019

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• 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-ASSOCIATEDBLOODSTREAM INFECTIONS (CLABSI)

AIM STATEMENTTo reduce the current CLABSI average rate by 50% (from 0.7 to 0.35) by December 31, 2019.

MEASURESOutcome 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 Vana@sutterhealth.org

sutterhealth.org/mmc