Aiming for zero: decreasing central line associated bacteraemia in the intensive care unit

Area of Science:

• Healthcare quality improvement
• Infection control in critical care settings
• Patient safety in intensive care units

Background:

• Central Line Associated Bacteraemia (CLAB) poses a significant risk to patients in intensive care units (ICUs).
• Effective strategies are needed to reduce CLAB and improve patient outcomes in critical care environments.

Purpose of the Study:

• To eliminate Central Line Associated Bacteraemia (CLAB) within the Critical Care Complex (CCC) at Middlemore Hospital.
• To implement and evaluate a multifaceted quality improvement program for CLAB prevention.

Main Methods:

• A comprehensive quality improvement program was implemented, involving leadership engagement and staff education.
• Standardized checklists for central line insertion and maintenance, along with a dedicated central line pack, were introduced.
• Rapid, visual feedback mechanisms were utilized to monitor and report CLAB rates.

Main Results:

• Absolute CLAB cases in the CCC decreased from 14 in 2008 to 1 in the first half of 2010.
• The CLAB rate per 1,000 line days dropped from 6.6 to 0.9, with periods of zero CLAB exceeding 100 days.
• Patient mortality associated with CLAB was 37%, compared to 13% for other ICU patients, and significant cost savings of $460,000 were realized in 2009-2010.

Conclusions:

• An evidence-based quality improvement approach can significantly reduce Central Line Associated Bacteraemia in critical care settings.
• Implementing standardized protocols and feedback systems effectively lowers patient morbidity and mortality.
• Successful CLAB reduction strategies lead to substantial cost savings, reallocating resources to other healthcare needs.