CLABSI Steering Committee
Beth Day, MSN, APN, CCNS, CCRN and Leslie Klemp, MS, RN, NE-BC
Central line-associated bloodstream infections (CLABSIs) are one of the most significant healthcare-associated infections (HAI) in the hospital setting. CLABSIs result in increased lengths of stay, increased health care costs, and higher mortality rates.
Evidence that CLABSIs are largely preventable has created opportunities for health care organizations to implement evidence-based bloodstream infection prevention practices to reduce or eliminate these infections.
In response to an increasing Standardized Infection Ratio (SIR), a rapid improvement event (RIE) was held in October 2016 to complete an internal root cause analysis of our rising CLABSI rate. From this event, a hospital-wide nursing committee was formed to develop interventions designed to drive down CLABSI rates. Three key interventions implemented include the 2 RN central line maintenance bundle checklist completed at every handoff, institution of 2 RN PICC line dressing changes, and development of the CHG treatment policy and associated education. After education and documentation changes, compliance increased from 64 to 86 percent by the end of three months.
Despite these interventions, CLABSI continued to be a patient safety risk. In March 2017, the multidisciplinary CLABSI steering committee was formed comprised of a performance improvement consultant from quality improvement, an infection preventionist from infection prevention and control, and clinical nurse specialists and educators from adult critical care, adult acute care, pediatric critical care, and neonatal critical care. In an effort to support and confirm nursing practice, Leadership ͞Eyes on Lines͟ rounds were piloted in May 2017 and data reviewed in June 2017. The CLABSI SIR decreased from 0.77 in April to 0.39 in May.
Neonatal Intensive Care Unit: War on CLABSI
Vanessa Harvey, BSN, RN and Anne McDonald, BSN, RNC-NIC
The Neonatal Intensive Care Unit (NICU) had three central line-associated bloodstream infections (CLABSIs) in FY17. The NICU infection prevention committee and NICU leadership put an action plan in place with the goal of no more than one CLABSI for the remainder of FY17 (with a stretch goal of 0 CLABSI). The NICU has been CLABSI-free since Dec. 28, 2017.
This fiscal year, the neonatal intensive care unit (NICU) established a CLABSI prevention action plan.The NICU action plan began with a multidisciplinary group of attending physicians, RN Handoffs, staff nurses, lactation consultants, and respiratory therapists, including the following: Deb Gist, NICU unit director; Dr. Jean Silvestri, NICU medical director; Dr. Rob Kimura, medical director; Dr. Christie Lawrence, NICU clinical nurse specialist; John Overby, NICU clinical nurse educator; Tiffany DeRiggi, NNP; Megan Jones, NNP; Anne McDonald, NICU RN3, NICU infection prevention control leader; Cathy Heinzinger, NICU RN3; Mary Beth Byrne, RN3; Brooke Schwartz, RN3 NICU CNL; Joyce Kilpatrick, RN2; Marcelina Wawrzyniak and Tiffany Wiksten, infection preventionists, Infection Prevention and Control; and Leslie Klemp, performance improvement consultant, Quality Improvement.
Their multi-faceted plan included, but was not limited to the following key factors:
- hand hygiene communications
- bundle compliance
- use of chlorhexidine bath clothes and daily bath compliance
- family CLABSI education
- product changes
- incorporation of CLABSI discussion during bedside rounding
- best practices review with the pediatric intensive care unit
- engaging all levels of the tam to help improve practice and outcomes
Noncompliance with central line dressing integrity was noted. The following actions went into place to improve this compliance:
- On Jan. 19, 2017, visual central line audits (VCLA) were started by NICU nursing staff and nursing leadership members. These audits are now continued by NICU nursing leadership and three infection prevention control members. The VCLA includes checking: correct documentation of lines in EPIC, correct labeling of tubing, evaluation of dressing integrity, and timely x-rays to confirm line placement. Audits are completed with the bedside RN and episodes of noncompliance are emailed to individual staff and NICU nursing leadership.
- On May 23, 2017, a central line dressing change education PowerPoint presentation was developed and is currently used during monthly skills days.
- Staff was educated on dressing changes and integrity via a Leap Module; this module was completed by all NICU staff prior to May 1, 2017.
Hand hygiene/standard precaution compliance:
- A "clean to baby" audit was created and initiated on Aug. 27, 2017. In response to auditfindings on Dec. 22, 2016, an educational tool was developed and disseminated to re-educate NICU staff about hand hygiene/standard precaution compliance.
CLABSI prevention was further addressed with bath and chlorhexidine treatments. The following actions went into place to improve this compliance:
- Chlorhexidine treatments were implemented in the NICU in April 2017. Treatments are based on gestational/chronological age.
"When we first thought we had a CLABSI this past December, we rallied our team and began an investigation before the culture had been finalized and Infection Prevention and Control had been called," says Jean Silvestri, MD, NICU medical director. "Our collaborative team is truly engaged to reduce and eliminate CLABSIs in our unit."