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Reducing Central-Line-Associated Bloodstream Infections (CLABSI): An Improvement Project in a Specialized Tertiary
Fadwa Abu Mostafa1, Khaled Alnafee1, Khadijah Al Shanqiti1
1King Faisal Specialist Hospital and Research Centre, Saudi Arabia.
Insights
A hospital successfully reduced central-line-associated bloodstream infections (CLABSI) by 35% through a performance improvement project. This initiative involved standardized procedures, staff training, and patient engagement, leading to significant reductions in infection rates.
Area of Science:
- Healthcare Quality Improvement
- Infection Prevention and Control
- Hospital Epidemiology
Background:
- Central-line-associated bloodstream infections (CLABSI) are a significant cause of hospital-acquired infections, leading to prolonged stays and increased costs.
- A baseline of 144 CLABSI events in 2017 highlighted the need for a targeted performance improvement initiative.
Purpose of the Study:
- To implement and evaluate a performance improvement project aimed at reducing CLABSI events in a hospital setting.
- To decrease the incidence of hospital-acquired infections associated with central venous catheters.
Main Methods:
- Utilized brainstorming and driver diagrams to generate change ideas.
- Employed Plan-Do-Study-Act (PDSA) cycles for iterative implementation and monitoring.
- Implemented a bundle of interventions including standardized central line procedures, simulation-based physician training, an awareness campaign, root cause analysis, and electronic health record documentation.
Main Results:
- Achieved a 35% overall reduction in CLABSI events from the 2017 baseline.
- Reduced the CLABSI rate from 1.5 to 1.03 per 1000 device days.
- Ten units reported zero CLABSI events in 2018 and 2019, with four high-utilization units achieving this outcome.
Conclusions:
- The implemented interventions were effective in significantly reducing CLABSI events.
- Continued monitoring and implementation of further interventions are planned to achieve zero CLABSIs across all hospital units.
Introduction:
Central-line-associated bloodstream infections (CLABSI) are preventable hospital-acquired infections that harm and prolong a patient's hospital stay and increase unnecessary hospital expenditure. In collaboration with infection control and hospital epidemiology, the quality management department initiated a performance improvement project to address 144 CLABSI events in 2017.
Methods:
The performance improvement project team used brainstorming to create change ideas presented in a driver diagram. The team then applied plan-do-study-act (PDSA) cycles to implement and monitor the improvements. Finally, the team applied a bundle of interventions that included the following: (a) policies and procedures for central line insertion, maintenance and removal processes standardization, (b) physicians training for line insertion by simulation, (c) an awareness campaign that included recognizing healthcare workers and enhancing patient engagement, (d) performing root cause analysis for the CLABSI events, and (e) automation of central line insertion, and (f) maintenance bundles documentation in the hospital information system.
Results:
The CLABSI rate per 1000 patient days dropped from 1.5 per 1000 device days to 1.03 per 1000 device days. In addition, CLABSI events reduction was 24% by 2018. Then further reduction of 15% occurred by the end of 2019. Thus, the overall decrease in CLABSI events was 35% from the baseline number of events (i.e., 144 events) in 2017. Another achievement of the project is that 10 units reported zero CLABSI events in 2018 and 2019, of which four units had a high central line utilization rate, more than 40%.
Conclusion:
The implemented interventions effectively reduced the CLABSI events in the hospital. The project team will continue implementing more interventions with monitoring, aiming to achieve zero CLABSIs over time in all the hospital units.
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