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Modification of anesthesia practice reduces catheter-associated bloodstream infections: a quality improvement
Lizabeth D Martin1, Sally E Rampersad, Jeremy M Geiduschek
1Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98103, USA. Lizabeth.Martin@seattlechildrens.org
Insights
Anesthesia providers improved operating room cleanliness, significantly reducing catheter-associated bloodstream infections (CABSI) in patients traveling outside the ICU. This initiative led to a notable decrease in hospital-wide CABSI rates.
Area of Science:
- Healthcare quality improvement
- Infection control
- Anesthesiology practice
Background:
- Catheter-associated bloodstream infections (CABSI) pose a significant hospital challenge.
- In 2009, patients traveling from the ICU with anesthesiologists had higher CABSI rates.
- A need existed to reduce intraoperative contamination and subsequent CABSIs.
Purpose of the Study:
- To develop strategies for enhancing intraoperative cleanliness by anesthesia providers.
- To minimize contamination of intravenous access points during patient transport and procedures.
- To ultimately decrease the incidence of catheter-associated bloodstream infections.
Main Methods:
- A multidisciplinary team identified barriers to best practices for preventing intravenous line contamination.
- Continuous Performance Improvement (CPI) and Lean techniques were employed.
- Staff developed and implemented countermeasures, supported by coaching and feedback.
Main Results:
- CABSI rates for patients traveling off the ICU decreased from 14.1/1000 trips in 2009 to 0/1000 trips in 2011.
- Hospital-wide CABSI rates declined from 3.5/1000 central line days to 2.2/1000 central line days.
- Intervention demonstrated significant reduction in infection rates.
Conclusions:
- Modifying anesthesia provider practices in the operating room can reduce workspace contamination.
- These practice changes are directly associated with a decrease in catheter-associated bloodstream infections.
- Targeted interventions can effectively improve patient safety and reduce infection rates.
Background:
A major strategic hospital goal is the prevention of catheter associated bloodstream infections (CABSI). In 2009, at our institution, the CABSI rate for patients who traveled out of the ICU to the operating room and other procedural areas under the care of an anesthesiologist was increased compared to patients who remained on the unit.
Aims:
Our objective was to develop countermeasures to improve intraoperative cleanliness by anesthesia providers, minimize contamination of intravenous access points, and ultimately reduce CABSIs.
Materials & Methods:
A multidisciplinary team identified barriers to following best practices for reducing contamination of intravenous line entry-ports. Using Continuous Performance Improvement (CPI) or Lean techniques, staff directly impacted by the changes developed countermeasures to improve anesthesia practice. Compliance with the new "best practices" improved with coaching and feedback.
Results:
Postimplementation, CABSI rates for patients traveling off the ICU with anesthesiology providers decreased from 14.1 per thousand trips off the ICU preintervention in 2009 to 9.7 per 1000 trips in 2010 and to 0 per 1000 trips in 2011 postintervention. Hospital-wide CABSI rates decreased from 3.5 per 1000 central line days preintervention to 2.2 per 1000 central line days after.
Conclusion:
Practice modification by anesthesiology providers in the operating room can decrease workspace contamination and is associated with decreased CABSI rates.
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