Prevention of Central Line-Associated Bloodstream Infections by Leadership Focus on Process Measures

Area of Science:

• Healthcare Quality Improvement
• Infection Prevention and Control
• Epidemiology

Background:

• The COVID-19 pandemic disrupted hospital-acquired infection (HAI) prevention efforts, notably impacting central line-associated bloodstream infection (CLABSI) standardized infection ratios (SIRs).
• An observed increase in CLABSI SIRs in early 2021 prompted a targeted intervention within a midwestern healthcare system.

Purpose of the Study:

• To evaluate the impact of a focused quality improvement initiative on CLABSI prevention processes and outcomes.
• To assess changes in CLABSI SIRs and related process measures following the implementation of standardized best practices.

Main Methods:

• A healthcare system with 12 acute care hospitals established CLABSI triads comprising medical provider, nursing, and infection prevention leads.
• Initiatives focused on best practices, standardized technology, and compliance reporting were implemented from July 2021 through December 2022.
• Interrupted time series analysis was used for CLABSI SIRs and standardized utilization ratios (SURs); Wilcoxon rank sum exact testing analyzed process measures.

Main Results:

• A 47.5% decrease in CLABSI SIRs was observed, reaching 0.61 from 2023 to April 2024.
• A significant downward trend was noted in CLABSI SIRs (p=0.04) and central line utilization (p<0.01) during the intervention period.
• Statistical improvement in CLABSI prevention best practices was achieved.

Conclusions:

• Intensive leadership focus on key CLABSI prevention process measures is directly associated with reduced CLABSI SIRs.
• Targeted quality improvement strategies can effectively mitigate the impact of external factors, such as pandemics, on infection control outcomes.