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Reducing CLABSIs in an Adult Cardiothoracic ICU
Emmanuel Orozco-Santana1, Taryn Fowlds, Michelle Tamayo
1Emmanuel Orozco-Santana , Taryn Fowlds , Michelle Tamayo , Christine Jew , and Patricia Young are clinical nurses II, Patty Sheehan is a cardiac clinical nurse specialist, Katrine Murray is the unit director, and Taline Marcarian is a clinical nurse III, all in the cardiothoracic ICU at Ronald Reagan UCLA Medical Center in Los Angeles. Contact author: Taline Marcarian, tmarcarian@mednet.ucla.edu . The authors have disclosed no potential conflicts of interest, financial or otherwise.
Insights
Implementing evidence-based strategies significantly reduced central line-associated bloodstream infections (CLABSIs) in a cardiothoracic ICU. This quality improvement initiative sustained low CLABSI rates over multiple years.
Area of Science:
- Healthcare quality improvement
- Infection prevention and control
- Patient safety in critical care
Background:
- Central line-associated bloodstream infections (CLABSIs) present a significant clinical challenge, increasing mortality and healthcare costs.
- In fiscal year 2018, the cardiothoracic intensive care unit (CTICU) reported nine CLABSIs, highlighting a critical need for intervention.
Purpose of the Study:
- To decrease the incidence of CLABSIs within the CTICU.
- To implement and sustain interventions aimed at reducing CLABSI rates.
Main Methods:
- A quality improvement project initiated by nurse residents, evolving into an ongoing unit-based initiative.
- Implementation of evidence-based interventions including comprehensive education, structured rounding, regular auditing, and unit-specific strategies like "Central Line Sunday" and a blood culture algorithm.
Main Results:
- CLABSI incidence decreased from nine in FY 2018 to one in FY 2019 and FY 2020, and two in FY 2021.
- The CTICU achieved an extended period of over 365 days with zero CLABSIs from August 2019 to November 2020.
Conclusions:
- Nurses successfully reduced CLABSIs through the adoption of novel, evidence-based strategies and consistent monitoring.
- Strong nursing leadership support was crucial for the successful implementation and sustainability of these infection prevention interventions.
Local Problem:
Central line-associated bloodstream infections (CLABSIs) are associated with increased mortality and costs. In the cardiothoracic ICU (CTICU) of an academic medical center, nine CLABSIs occurred in fiscal year (FY) 2018.
Purpose:
The aim of this project was to reduce the CLABSI rate in the CTICU and sustain the results.
Methods:
Nurse residents on the CTICU initiated a quality improvement project with a single intervention and expanded it into an ongoing initiative with additional interventions by the unit-based performance improvement committee. Evidence-based interventions were identified and implemented, including education; rounding; auditing; and other unit-specific interventions, which included "Central Line Sunday," accountability emails, and a blood culture algorithm with a tip sheet.
Results:
CLABSI incidence was reduced from nine in FY 2018 to one in each of the subsequent FYs (2019 and 2020), which had similar totals of central line days, and two in FY 2021, which had a slightly higher number of central line days. The CTICU was able to achieve zero CLABSIs from August 2019 through November 2020, more than 365 days.
Conclusions:
Coupled with strong support from nursing leadership, nurses on the unit successfully reduced CLABSIs by adopting novel, evidence-based strategies; ongoing monitoring; and multiple interventions.
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