Reducing Adult Central Line Related Bloodstream Infections.

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Presentation transcript:

Reducing Adult Central Line Related Bloodstream Infections

Team Infection Prevention and Control Department

OPPORTUNITY STATEMENT Reduce adult intensive care central line bloodstream infections to below the benchmark of 3.0/1000 central line days by implementing interventions based on national guidelines and successful practice at other healthcare organizations

Solutions Implemented  Presentation of the project and goal to the ICU Medical Directors and managers to enlist cooperation  Multidisciplinary committee developed and implemented protocols and guidelines based on best practice  Two month surveillance of bloodstream infections in all adult ICUs to establish a baseline (November and December, 2004)  Implementation of a standardized central line insertion protocol on all ICUs  Introduction of anti microbial coated central line catheters in kits containing Chloroprep, full body sterile drape and safety devices

Solutions Implemented  Insertion guidelines written and disseminated to staff including daily assessment of the need for a central line  Standardized supply lists for line insertion and care posted in all ICU supply rooms  Education and testing of faculty, residents and nursing staff on central line insertion protocols through e-learning modules  Data provided to ICU Medical Directors, ICU Nurse Managers, and physician department chairs showing a significant decrease in infection rate and all reminded to continue to practice the insertion guidelines  Follow up two month surveillance of bloodstream infection in all adult ICUs to compare to previous year (Nov-Dec, 2005)

ADULT ICU CLR-BSI RATES FOR QUALITY IMRPOVEMENT PURPOSES ONLY p chart Set 2: UCL=0.75, Mean=0.28, LCL=none (25-38) Inspected Mean = , Counts Mean = /1/20032/1/20033/1/20034/1/20035/1/20036/1/20037/1/20038/1/20039/1/ /1/200311/1/200312/1/2003 1/1/20042/4/20043/4/20044/4/20045/4/20046/4/20047/4/20048/4/20049/4/ /4/200411/4/200412/1/2004 1/1/20052/1/20053/1/20054/1/20055/1/20056/1/20057/1/20058/1/20059/1/ /1/200511/1/200512/1/2005 1/1/ UCL = 1.12 Mean = 0.51 UCL = 0.75 Mean = 0.28 GOAL ICU POINT PREVALENCE IN NOV AND DEC 2004 ANTIMICROBIAL CATHETERS PHASED IN OVER NEXT 6 MONTHS INSERTION GUIDELINES DISSEMINATED MARCH 11, 2005 E-LEARNING ACTIVATED MAY 27, 2005 Adult Intensive Care Central Line Related Bloodstream Infection Rates 1/ /1/20033/1/20034/1/20035/1/20036/1/20037/1/20038/1/20039/1/ /1/200311/1/200312/1/2003 1/1/20042/4/20043/4/20044/4/20045/4/20046/4/20047/4/20048/4/20049/4/ /4/200411/4/200412/1/2004 1/1/20052/1/20053/1/20054/1/20055/1/20056/1/20057/1/20058/1/20059/1/ /1/200511/1/200512/1/2005 1/1/ Mean = 5.1 Mean = 2.8 GOAL ICU POINT PREVALENCE IN NOV AND DEC 2004 ANTIMICROBIAL CATHETERS PHASED IN OVER NEXT 6 MONTHS INSERTION GUIDELINES DISSEMINATED MARCH 11, 2005 E-LEARNING ACTIVATED MAY 27, 2005 Bloodstream Infections per 1,000 Central Line Days

Results Central line related bloodstream infections in adults decreased from a mean of 5.1/1000 central line days to 2.8/1000 central line days

RESULTS (continued) Average cost per bloodstream infection: $56,000 * 34 fewer infections in 2005 than x $56,000 = $1,904,000 in savings * O’Grady NP. Alexander M, Dellinger EP, et al: Guidelines for the prevention of intravascular catheter-related infections. MM/WR Recomm Rep; (RR-10): 1-29

Next Steps  In January, 2006 resume routine catheter line related bloodstream surveillance in ICUs based on the current schedule of ICU monitoring.  Present data at adult ICU Quality Improvement meetings for discussion.  Investigate the process of insertion and maintenance of central lines on patients who had infections and make improvements in practice as needed.