Getting to zero central line associated bloodstream infections: A multidisciplinary quality improvement project in a
Alexander Kurjatko1, Robertino Simpson1, Sarah Wellsandt2
1Acute Care Surgery Division, Department of Surgery University of Iowa, Iowa City, IA, USA.
Background:
Thermally injured patients are at higher risk for central-line-associated bloodstream infections (CLABSIs) than other critically ill patients. Despite this, the expectation is zero CLABSI for the burn population. Scarce literature exists regarding CLABSI prevention in burn-injured patients, with literature indicating divergent recommendations for the thermally injured compared to other critically ill cohorts. We undertook a quality improvement project (QI) to decrease our CLABSI rates.
Methods:
All burn patients 15 years and older who were admitted to our burn unit from 2017 to 2022 with a central line placed during their stay were included. The burn team instituted a multidisciplinary CLABSI intervention in three phases that focused on education, line necessity discussions, and protocoled replacement of central lines. Chi-square, Fisher exact and Mann-Whitney tests were used to compare variables between those with and without CLABSIs.
Results:
Eight patients developed nine CLABSIs. The study phases were similar with respect to clinically assessed variables. Patients with CLABSIs had larger burns, more central lines, more ventilator days, and longer lengths of stay. The CLABSI rate was 3.5 % during the control period. After initially increasing, the rate decreased to 1.3 % in phase 3 with no CLABSIs in the subsequent year (2023). Only line days were independently related to CLABSI, with an increase of 6.7 % for each day the central line was in place.
Conclusions:
This multidisciplinary project was associated with a decrease in the CLABSI rates in burn patients reaching zero CLABSIs the following year. As this practice is counter to national central line management recommendations, it is imperative that multicenter prospective studies systematically evaluate the practice of routine line changes as part of CLABSI prevention in burn patients.
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