Getting to Zero Strategies to Reduce Central Line Associated Bloodstream Infections (CLABs) Brian S. Koll, MD, FACP Medical Director, Infection Prevention Chief, Epidemiology Beth Israel Medical Center, New York, NY

Beth Israel Medical Center 2004 Petrie Division Kings Highway Division 94 ICU beds –3,000 discharges 824 non-ICU beds –43,000 discharges > 3,000 central lines placed annually BIMCUSA Patients in ICU with Central Line 40%48% CLABs Rate per 1,000 line days CLABs Rate per 100 patients 2%4% Increase LOS5 d14 d

Used BI BSI information and discharge information from 2004 Costs Incurred Care of Patients with CLABs Annual Incremental Costs Incremental Cost Per CLAB Patient CLAB Patients Discharges Per Year 94 ICU Beds $960,000$40, ,000 $1,510,000 Total Incremental CLAB Costs 824 Non-ICU Beds $550,000$25, ,000

Leadership Administrative Clinical Physician and Nursing Champions

American Journal of Infection Control 2008;36: Everyone has the ability, permission and responsibility to “stop the line” to prevent risk to patients (and staff) All are empowered to identify and change (or eliminate) risky processes, no matter when, where or who is involved and always without fear of retaliation There is participatory management at every level of the organization with both top-down and bottom-up communication Integrity and trust are woven into the fabric of the organizational culture Everyone is engaged in the prevention system, and there is reciprocal responsibility

Inter-disciplinary Team Members Physicians Chief Executive Officer Chief Medical Officer Administrative Intern Associate Chairman, Department of Medicine Director –ICU, MICU, SICU –Emergency Room –Medical Residency Programs Intensivist Critical Care Fellow Residents and Interns Medical Student Infection Control Hospital Epidemiologist Manager Practitioner Patient Care Services Vice President Director Nurse Manager –ICU, MICU, SICU Nurse Education Manager New Nurses Nursing Student Other Director –Materials Management –Housekeeping –Respiratory Therapy –Quality Improvement Pharmacist Pharmacy Intern Radiology Transport Services

Multi-disciplinary CLABs Team Principles It is not good enough that our infection rates are below national benchmarks. CLABs are preventable, they are not an inevitable consequence of sophisticated, complex care that we provide to our severely ill patients. CLABs can be eliminated by determination as opposed to additional resources.

8 Strategies to Reduce Central Line Associated Bloodstream Infections (CLABs)

Beth Israel Medical Center CLABs Prevention ICUs

Beth Israel Medical Center CLABs Prevention Unit Longest Duration of Days Without CLAB CCU644 ICU601 ED547 SICU483 PICU396 non-ICU345 MICU344 CSICU300

CLABs Collaborative Infection Results 11 Reporting Period CLABs Rate per 1,000 Line Days

CLABs Prevention ICUs 12