What is a Central Line-Associated Bloodstream Infection (CLABSI)? A “central line” is an intravenous catheter that is placed into a large vein in a patient’s neck, chest, arm, or groin and ends near the heart or in a large central vein. It is different than a regular IV catheter. It is used to draw blood, give fluids or medications, and it may be left in place for a long period of time, even for outpatient therapy. Having a central line places a patient at risk for developing an infection unless best practices are performed to prevent it. A bloodstream infection can occur when bacteria or other germs enter the blood as part of using this catheter to provide care, by maintaining the catheter, or through the area where it is inserted into the body. A central line-associated bloodstream infection is serious, but often can be successfully treated.
Prevention of central line-associated bloodstream infections include the following best practice bundle measures: hand washing before and after inserting the catheter, selecting the optimal body location, using maximum sterile barrier drapes and attire during the insertion, using chlorhexidine gluconate and alcohol skin preparation for all patients over 2 months of age, using antimicrobial impregnated catheter and Chlorhexidine gluconate impregnated dressing, inserting the lowest number of lumens needed for care, aseptic management of the lines, tubings and fluids, and changing the catheter only when needed and removing it when it is no longer necessary. Collaboration between all three BH hospitals has resulted in the development and adoption of an online invasive line procedure note which promotes and documents the use of evidence-based interventions, as well as the pre-procedure time out. This note also provides documentation to assist in practice variance during root cause analysis in the event a CLABSI develops.
Highlights
Baystate Medical Center
- A mandatory online education program and mentoring by expert clinical staff have been incorporated into learning.
- Best practices for insertion of central lines are taught and validated in the Simulation/Skills Center.
- Dedicated advanced practice nurses insert lines in the NICU, Interventional Radiology and on the IV team.
- Baystate Medical Center participates in the Massachusetts Hospital Association Getting to Zero Campaign to eliminate CLABSI. Our multidisciplinary task group is working on 5 areas of improvement and standardization: education, criteria for insertion, bedside staff engagement, supply standardization, and documentation.
- Each CLABSI that occurs is reviewed in a "Root Cause Analysis," identifying areas for improvement or gaps in current practice for ongoing learning and improvement of patient care.
- In our second year of prevention activities, drilling down to insertion criteria and practices, documentation, and the development of an infection control policy for the prevention of central line-associated bloodstream infections are highlights of our current task group work.
- Standardization of line carts, line site care kits, equipment, products, policies, and procedures for insertion and post-insertion care have helped to significantly decrease rates of central line-associated bloodstream infections hospital-wide.
- Compliance with the evidence-based blood stream infection bundle is consistently high.
- The ICU and CVICU have joined the nationally recognized Comprehensive Unit-Based Safety Program (CUSP) to enhance patient safety in the intensive care setting.
- The NICU has joined the national NCABSI ( NICU CUSP) program, actively participating and sharing best practices as our NICU has reached 563 days without a CLABSI.
- Focus housewide is on reducing CLABSI and reporting patient outcomes on a monthly basis.
- The CLABSI rate in many inpatient units is currently 0%.
- Housewide we celebrated Zero CLABSI for the month of May 2012, with the housewide rate for the quarter at 0.5 CLABSI/1000 central line days.
Baystate Mary Lane Hospital
- “Central Line Kits” have been assembled and contain all necessary personal protective equipment to ensure compliance with insertion guidelines. A Central Line Bundle Check List is included in the cart and prompts staff to complete the CIS online documentation.
- All “central line bundle measures” are tracked and reported semi-annually. Compliance with the evidence-based blood stream infection bundle is consistently high.
- There have been no central line-associated bloodstream infections in the past 5 years.
Baystate Franklin Medical Center
- Compliance with the insertion bundle has been at 100% for over 20 months.
- There have been no infections attributable to the ICU for the last four years.
- Data related to central line-associated bloodstream infections are monitored by the Infection Control Committee and by the Medical-Surgical and Critical Care Service Line Teams.
Baystate Home Infusion & Respiratory Services
- BHI&RS has implemented all of the BH recommended central line-associated bloodstream infection prevention interventions, including bio-patch and chlorhexidine gluconate dressings.
- For CY 2012 (year to date), the central line-related bloodstream infection rate is slightly higher than the Strategic Homecare Programs national benchmark.
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