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Reducing Central Line-Associated Bloodstream Infections in Three ICUs at a Tertiary Care Hospital in the United Arab
Kalpana K Reddy1, Asha Samuel, Kathleen Ann Smiley
1Critical Care Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
Insights
A quality improvement project significantly reduced central line-associated bloodstream infections (CLABSI) by implementing evidence-based interventions and staff engagement. This initiative decreased CLABSI rates by nearly 50% in intensive care units.
Area of Science:
- Healthcare Quality Improvement
- Infection Prevention and Control
- Patient Safety in Critical Care
Background:
- Central line-associated bloodstream infection (CLABSI) presents a significant challenge, contributing to increased patient morbidity and mortality.
- A quality improvement initiative was launched at a tertiary care hospital to halve CLABSI rates within intensive care units (ICUs).
Purpose of the Study:
- To implement and evaluate a multifaceted intervention program aimed at substantially reducing CLABSI rates.
- To improve patient safety and outcomes in ICUs through targeted infection control strategies.
Main Methods:
- A phased approach was employed, starting with a central line insertion bundle, checklists, and staff education.
- Subsequent stages included implementing maintenance bundles, a CLABSI prevention policy, CLABSI champions, unit-based safety programs (CUSP), and a "back to basics" campaign.
Main Results:
- CLABSI rates decreased significantly from a mean of 2.99 to 1.47 per 1000 central line days (p < .0001).
- The post-implementation period showed a significant increase in CLABSI-free days compared to the pre-implementation period.
Conclusions:
- A combination of evidence-based interventions, standardized procedures, and enhanced teamwork was effective in reducing CLABSI rates.
- Involving front-line staff in decision-making processes was crucial for the success of the CLABSI reduction initiative.
Background:
Central line-associated bloodstream infection (CLABSI) is associated with significant morbidity and mortality. A quality improvement project was conducted to decrease CLABSI rates by 50% across all ICUs in a tertiary care hospital (Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates).
Methods:
A multifaceted interventional program was implemented in a drive to reduce CLABSI rates. Stage 1 of the intervention entailed implementation of a central line insertion bundle, an insertion checklist, dedicated central line trolleys, education of all staff involved in insertion and maintenance of central lines, and empowerment of nurses. Stage 2 entailed implementation of a maintenance bundle and a CLABSI prevention policy and inclusion of central line assessment in the daily goals. Stage 3 was implemented in the form of CLABSI champions, spot checks on maintenance techniques, and review of every CLABSI. Stage 4 entailed the implementation of a Comprehensive Unit-based Safety Program (CUSP). Stage 5 consisted of a "back to basics" campaign, which included refocusing on basic evidence-based care bundles, introduction of bundle-compliance verification, and educational sessions and awareness programs.
Results:
Overall CLABSI rates significantly decreased (p < .0001) from a mean of 2.99 (standard deviation [SD], 1.69) in the preimplementation period (January 2008-June 2011) to 1.47 (SD, 1.01) in the postimplementation period (July 2011-August 2014) across all ICUs. Overall, there were significantly more months with CLABSI-free days in the post-implementation than in the preimplementation period.
Conclusion:
The combination of evidence-based interventions, standardization of procedures, teamwork, and front-line staff involvement in the decision-making process contributed to decreases in CLABSI rates across three ICUs.
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