REDUCING CENTRAL LINE BLOODSTREAM INFECTIONS Going beyond the checklist Richard T. Ellison III, MD June 2009

Improvement Strategy  FY 2004 – Creation of Critical Care Operations Committee  FY 2005 – Creation of Centerwide CL-BSI taskforce created: Use of a checklist, central line cart, full barrier precautions, and physician and staff education was implemented.  FY use of Chlorhexidine impregnated dressings on all central lines  FY monthly report on CL- BSI rates in each ICU to full CCOC  FY2006 – educational presentations and discussions with front line staff in each ICU on CL-BSI in rotation with other CCOC quality initiatives

Improvement Strategy  FY on line education of all ICU physicians and staff on presenting central line infections  FY2007 – routine use of antimicrobial impregnated central line catheters begun for catheters placed in ICU  FY2007 – “High risk” lines identified through ICU electronic medical record with notification of ICU directors (those placed in emergency department and at femoral site)

Improvement Strategy  FY a reduction in CL-BSI rates in the ICUs became a hospital goal with financial implications for hospital senior administration as well as CCOC director and ICU directors  FY2008 – education on proper blood culture collection technique provided to all ICU staff  FY2008 – each CL-BSI treated as a “critical” event with a follow up review meeting held with ICU unit director, ICU nurse manager, infection control department staff, and CCOC leadership  FY2008 – an atlas of dressing options for central line catheters placed at internal jugular site was created for situations where individual patient’s anatomy made it difficult to maintain an intact dressing  FY2009 – the rate of contaminated blood cultures collected in individual ICUs is reported back to individual ICUs

SUMMARY  A sustained reduction in CL-BSIs achieved across 7 ICUs has been achieved with over 80% reduction from baseline  Key factors to improvement have included: A commitment by Senior management to change approach to ICU care Ongoing feedback Interactive staff education  Best practices from one unit shared with all others Adoption of new technologies Ongoing review of factors that contribute to each CL-BSI