A team approach to preventing healthcare acquired Central Line Associated Bloodstream Infections (CLABSI) in an urban acute care facility

Background: Hospital Acquired Infections (HAIs) are a major public health concern because of increased morbidity, mortality, length-of-stay, and financial burden. Central Line Associated Bloodstream Infections (CLABSIs) are among the most troubling of HAIs. An estimated 71,000 (CLABSI) occur in the United States annually resulting in some 33,000 deaths and approximately $2 billion in healthcare costs.

 In 2010, Harlem Hospital Center, a 282 bed urban acute care facility, had a CLABSI rate of 6.8% as compared to National Health Care Safety Network (NHSN) rate of 2.1 /1,000 line days. A Risk Assessment was done and the following goals were set: a) reduce CLABSI rate in Adult ICU and Non-ICU patients by 50%; and b) achieve 95% or greater compliance with use of CLABSI Prevention Bundle. 

Method: To achieve our goals we: a) educated staff on ‘best practices’, b) utilized Central Line Bundle,  c) reinforced and monitored Hand Hygiene, d) monitored use of maximal barrier precaution; e) used Chlorhexidine skin prep; f) conducted daily reviews at multidisciplinary rounds, g) ensured timely removal of lines; h) reviewed all CLABSI cases with clinical teams; i) empowered nurses to stop procedure if non-compliance with central line protocol was observed; and j) conducted daily inspection and documentation of site dressing.

Results: Over a period of 12 months we surpassed our goal, achieved a rate of zero CLABSI per 1000 central line days, and maintained this rate hospital-wide for over 36 months.

Summary: Hospital acquired infections contribute to extended length of stays, additional costs, and unhappy patients and families. Our results show that when best practices are adhered to CLABSIs can be prevented.